"E" is for everything else, not least for expanding HIV testing in Europe.

Editorials 634 In 2006, the director of the Department of HIV/AIDS in the World Health Organization (WHO) called for moving beyond the hotly debated strategy for the prevention of human immunode-ficiency virus (HIV) infection known as " ABC " (for abstain, be faithful, use condoms), with the addition of a " D " for " diagnosis " and an " E " for " everything else ". 1 We took this call literally and, together with colleagues from across Europe, in 2007 we cofounded the HIV in Europe initiative, aimed at improving and expanding HIV testing and linkages to earlier care. 2 Fast-forward five years and, in March 2012, HIV in Europe held its third major conference to discuss an array of testing-related issues and ways to take the initiative forward. Testing rates are unacceptably low everywhere, even in Europe. 3 In some eastern European countries, as many as 60% of those living with HIV are undi-agnosed, 4 and in the WHO European Region as a whole, nearly half of the 2.5 million people who are infected with HIV are diagnosed late in the course of their infection. Why do so many people not know that they are infected or get tested too late to obtain optimal care? These are some of the questions we seek to answer. While the 2012 conference reported on concrete study findings, this article explores the elements that should be a part of " E ". Encourage, empower, expand. To scale up testing, groups at higher risk for HIV infection, such as people who inject drugs, sex workers and men who have sex with men, need expanded opportunities and encouragement for HIV testing through targeted information on prevention. Just as importantly, however, they need to be empowered to take control of protecting their own health. Although high-risk populations are typically marginalized, in many parts of western Europe men who have sex with men are less marginalized now than in the past. In this group, HIV infection is on the rise again. 5 Quality counselling on preventing HIV transmission is needed for members of this community and of other groups at risk that are more difficult to reach. Hence, the HIV in Eu-rope initiative will prioritize counselling issues over the next two years. Ethics. Medical ethics prescribe that health-care providers should do no harm, yet in certain parts of Europe, particularly in the east, they often …