Scaling up HIV prevention: why routine or mandatory testing is not feasible for sub-Saharan Africa

Global HIV incidence may have peaked but calls for scaling up prevention have not diminished. The number of new infections worldwide remains high (4.1 million in 2005) with some regions previously unscathed experiencing rising incidences of HIV. The number of patients presenting late at health facilities with advanced HIV/AIDS is also a cause of concern. In general there is a growing sense of frustration that global efforts to prevent HIV/AIDS are being outpaced by the spread of the pandemic. Consequently calls have been made for a more pragmatic approach to containing the disease with routine and mandatory testing gaining increasing attention. The US Centers for Disease Control and Prevention (CDC) recently proposed a new approach for HIV testing in adults adolescents and pregnant women under which testing will be routinely offered in all health-care settings. No signed consent from patients would be required under this new proposal; the general consent for medical care would be considered sufficient to encompass consent for HIV testing. Former US President Bill Clinton has also lent support for mandatory HIV testing in countries where the prevalence rate is 5% or higher. Political support for mandatory testing has been seen in countries like India where the state government of Goa has proposed mandatory premarital testing and in China which plans to test all workers in the tourism industry. But would routine or mandatory testing make any difference in preventing HIV/ AIDS in sub-Saharan Africa? (excerpt)