Routine HIV testing: a view from Botswana.

ollowing an announcement in October 2003 by President Festus Mogae, routine testing for HIV (RHT) was introduced in Botswana in January 2004. It was assumed that RHT would reduce the stigma associated with the "exclusivity" of HIV testing, enable earlier testing, allow more timely access to treatment, and ultimately reduce the rate of infection.1-3 Botswana's first year of RHT has shown an increase in the accessibility of HIV testing and, consequently, in the number of people who have chosen to test. For RHT to be implemented in a manner that makes this increase meaningful, however, it needs to be positioned within a welldesigned strategy, including timely and thorough training in the health care sector. Although RHT was introduced in January 2004, guidelines were not introduced until the end of February; and at the beginning of 2005, both the training of health care practitioners and the development of training materials were still ongoing. Anecdotal reports and consultation with medical practitioners indicate that there is still confusion around key issues such as who should be offered RHT, what information or counseling should precede testing, and most worrisome what constitutes informed consent in the RHT context. The concern raised prior to the announcement of RHT that the "concepts of compulsory, routine, and mandatory testing have been used interchangeably" also continues to be reflected in anecdotes relating to the differences in how testing is handled at different testing sites.4 These reported inconsistencies indicate