Global Policy Forum

At the beginning of 2004, AIDS treatment in Botswana — a country with the world's second-highest rate of H.I.V. cases — was stagnating. The country was providing free antiretrovirals, but only one in 10 who needed the drugs was taking them.

Then Botswana made a simple change in the rules for AIDS testing that allowed the program to soar. Previously, Botswanans could get tested only after providing written consent and accepting extensive counseling. Now, unless they object, all patients entering a clinic or hospital are routinely given an AIDS test. The rate of testing has quadrupled. A third of Botswanans now know their H.I.V. status, and 85 percent of those who need treatment get it.

The American Centers for Disease Control and Prevention recommended late last month that such routine AIDS testing — called opt-out — become the standard in the United States. This is an important reform. It is even more crucial for poor countries, where 90 percent of those infected do not know it.

Unaids and the World Health Organization should move quickly to endorse opt-out AIDS testing. Their guidance is followed worldwide and will help rally needed help from outside donors. The current protocols for testing — with their strong emphasis on privacy and consent — were designed when little could be done to help people with H.I.V. Now antiretrovirals are being rolled out in every country. But without easy access to testing, people may find out they have AIDS only when it is too late to save their lives. They will also have spent years unknowingly passing on the infection.

Where opt-out testing has been used, few patients decline tests. Treating H.I.V. like any other disease could also help lessen the stigma. People who have been tested before they feel sick also start AIDS treatment earlier, and do better on it. And studies show that those who know their status are only half as likely to infect someone else, when compared with an H.I.V. carrier who is still in the dark. Governments need to follow Botswana's lead and make AIDS testing routine in every health clinic and hospital. And donors should ensure that every clinic has a reliable supply of AIDS tests.

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