Provider-Initiated HIV Testing Preferred Over Voluntary Counseling and Testing

Even as access to HIV prevention like HIV PEP, tests and treatment become more readily available, the uptake of HIV testing is relatively low especially in countries where at least 1% of the population is infected with the virus as well as countries with infection largely concentrated to the population of men who have sex with men, intravenous drug users, sex workers and migrants.

Recent research has revealed that about half the people who are HIV positive do not even know their HIV status. In order to increase HIV test coverage, a switch has been noted in HIV testing policies from Voluntary Counseling and Testing approach (VCT) to Provider-Initiated HIV testing and Counseling  (PITC).

PITC is in two forms: the universal approach where health providers offer routine HIV tests to all health service users or the targeted approach that offers routine HIV tests to those meeting particular symptomatic, behavioral or country-of-origin criteria.

New Testing Approach

The success in diagnosing new HIV infections is largely due to the effectiveness of at-risk individual outreach. As the PITC approach is being advocated and promoted a lot more, its actual effects on segments of the population with a lot of vulnerabilities like men who have sex with men and sex workers need to be monitored and assessed. There is also a need to collect and analyze the perspectives of both the providers of PITC as well as the users who participate. This data is important to monitoring if the principles of a rights-based approach to managing HIV are being adhered to. These principles are:

  • Consent
  • Counselling
  • Connection to prevention
  • Care & Treatment
  • Correct Test Results
  • Confidentiality

It is based on the above information that Barbara Navaza, Bruno Abarca, Federico Bisoffi, Robert Pool, Maria Roura affiliated to ISGlobal, Barcelona Centre for International Health Research, Hospital Clinic – Universitat de Barcelona, Spain and Centre for Social Science and Global Health, University of Amsterdam, The Netherlands decided to scrutinize the HIV testing experience and perspectives of migrant Latin-American men who have sex with men. transgender women living in Spain and healthcare providers.

The study was carried out between January 2013 and March 2014 through in-depth interviews and group discussions among men who have sex with men and transgender women of Latin-American origin as well as health professionals (HP) providing care to migrants to get their views and experiences on HIV testing using PITC.

The research was done in the two cities believed to host the largest number of migrants in Europe. The HPs were specifically and purposefully chosen from health institutions that have high numbers of migrants.

Suitability of Provider-Initiated HIV Testing and Counseling

The offer of an HIV test as a routine during medical encounters was generally viewed in positive terms. Constant contact between providers and users helped providers build trust and educate them on the importance of testing for HIV. PITC was also valued as an effective way to identify HIV positive cases at the very early stages of the infection.

The 5Cs Principles

Even though offering HIV testing at health facilities was generally accepted, the researchers observed some concerns about its adherence to the 5Cs principles that underpin the rights-based response to HIV, that is consent, counseling, connection to prevention, correct test results and confidentiality.

When it came to consent, the attitudes and procedures differed dramatically across settings among the HPs. A good number of them were aware of the importance of informing users and obtaining their consent before HIV testing. For others, they did not find a problem testing the users without informing them of what was going on.

HPs often skipped counseling before HIV testing to prevent users from the embarrassment of disclosing information on their sexual behavior. A list of endless questions discouraged some users from getting tested. Post-counseling was also skipped in many cases since both providers and users found it ineffective to promote safer sexual behavior.

Providers had a difficult time when it came to communicating HIV positive test results and for most it was an experience full of emotions. Also, access to treatment for undocumented migrants was a problem.

For most providers interviewed, confidentiality of the results was important. For many users, they felt that their privacy was better safeguarded at health facilities as opposed to specific community-based testing services.


PITC is viewed as acceptable to both users and providers especially towards efforts of normalizing HIV testing and detecting HIV positive cases in their early stages.

A good number of users valued the offer of a HIV test by a healthcare professional and found health facilities to be a convenient location for HIV testing. They viewed PITC as a dependable, convenient and a confidential approach to HIV testing and promoted testing among foreign-born sexual minorities.

Our Thoughts

In our view, PITC is an approach that, if efficiently used, could help detect HIV-positive cases at the early stages especially for groups who face intimidation and stigma from who they are or what they do such as gay people and commercial sex workers. This more proactive approach by the health care providers could also be extended to other forms of STD testing, not only HIV, since many of those most vulnerable to HIV are also vulnerable to a host of other STDs.

The full study can be found here: