The routine offer of HIV counseling and testing: a human right.

I or over a decade, the duty to obtain informed consent for HIV testing was one of the most inviolable precepts of the human rights approach to the HIV epidemic. In the course of 2004, however, a charge toward a "new approach" to HIV testing gathered pace and supporters. The year began with Botswana President Festus Mogae implementing a new policy of routine HIV testing under which, henceforward, all people in Botswana would automatically be offered an HIV test when they utilized health services.' Those who did not want an HIV test would have the right to "opt-out." Although the offer of an HIV test does not in and of itself violate the established principles of informed consent, it does shift the onus of requesting the test from the patient to the provider. This might appear an innocent shift, but in countries where the relationship between health users and providers is an unequal one, it is likely to be interpreted as a request to test rather than an offer. Later in the year, both UNAIDS and WHO, partly in response to Botswana's initiative, endorsed the "routine offer" of an HIV test and advocated mainstreaming HIV testing into health care services in countries with a high HIV prevalence.2 However, both organizations were careful to warn against the new approach being a cause of human rights violations and were careful to situate it within the human right to HIV prevention and treatment services.3 They also