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HIV testing in Europe : mapping policies and exploring practices in the era of increased treatment availability

(2014)
Author
Promoter
(UGent) and Herman Meulemans
Organization
Abstract
Summary When the HIV antibody test became available in 1985, it was mired in controversy: who should be tested, for what purpose, and under what conditions? In the absence of treatment and in the context of discrimination, HIV testing was embedded within exceptional procedures. With increasing treatment effectiveness, early HIV diagnosis became important, calling for normalisation of testing. With the objective to contribute to the understanding of how national HIV testing policies and practices are evolving in the context of a changing HIV testing paradigm, a health policy analysis has been undertaken. The core of the analysis concerned a multi-country study aimed at mapping national HIV testing policies in EU/EEA countries. The mapping study was complemented with an implementation study to investigate practices and barriers with regard to HIV testing. Current HIV testing policies exhibited a high level of exceptionalism, with informed consent and counselling constituting the normative base. Meanwhile, HIV testing practices are moving ahead faster than policies to accommodate changing contexts and practical needs. The study results showed that HIV testing is done in a wide variety of settings and that HIV testing is being normalised. In practice, there is less focus on pre-test counselling, yet more emphasis on post-test follow-up. However, there are barriers to testing which could cause a deficit in the normalisation since they are based on denial of risk and fear on the patients’ side and a certain embarrassment or awkwardness to address sexual health and HIV more actively on the providers’ side. The challenge lies now in the further accomplishment of the normalisation of HIV testing, with a clear focus on an efficient testing service delivery as being the starting-point of the HIV treatment cascade. For this, an improved understanding of the epidemic will provide a foundation for the development of an HIV testing model, considering the best mix of HIV testing approaches to achieve full coverage. However, for all HIV testing, the chief reason for testing must always be to benefit the individuals tested. Sufficient information should be provided to make an informed and voluntary decision to get tested whilst ensuring confidentiality and referral to appropriate follow-up services. To assure access to high-quality testing services which adhere to the guiding principles of HIV testing, the different testing approaches should be integrated within a national HIV testing policy framework. Finally, political commitment will be needed to reduce barriers to HIV testing, to support stakeholders at all levels in consolidating best practices and to expand targeted efforts within an enabling and supportive environment.

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Citation

Please use this url to cite or link to this publication:

Chicago
Deblonde, Jessika. 2014. “HIV Testing in Europe : Mapping Policies and Exploring Practices in the Era of Increased Treatment Availability”. Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
APA
Deblonde, J. (2014). HIV testing in Europe : mapping policies and exploring practices in the era of increased treatment availability. Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium.
Vancouver
1.
Deblonde J. HIV testing in Europe : mapping policies and exploring practices in the era of increased treatment availability. [Ghent, Belgium]: Ghent University. Faculty of Medicine and Health Sciences; 2014.
MLA
Deblonde, Jessika. “HIV Testing in Europe : Mapping Policies and Exploring Practices in the Era of Increased Treatment Availability.” 2014 : n. pag. Print.
@phdthesis{5784754,
  abstract     = {Summary

When the HIV antibody test became available in 1985, it was mired in controversy: who should be tested, for what purpose, and under what conditions? In the absence of treatment and in the context of discrimination, HIV testing was embedded within exceptional procedures.

With increasing treatment effectiveness, early HIV diagnosis became important, calling for normalisation of testing. With the objective to contribute to the understanding of how national HIV testing policies and practices are evolving in the context of a changing HIV testing paradigm, a health policy analysis has been undertaken. The core of the analysis concerned a multi-country study aimed at mapping national HIV testing policies in EU/EEA countries. The mapping study was complemented with an implementation study to investigate practices and barriers with regard to HIV testing.

Current HIV testing policies exhibited a high level of exceptionalism, with informed consent and counselling constituting the normative base. Meanwhile, HIV testing practices are moving ahead faster than policies to accommodate changing contexts and practical needs. The study results showed that HIV testing is done in a wide variety of settings and that HIV testing is being normalised. In practice, there is less focus on pre-test counselling, yet more emphasis on post-test follow-up. However, there are barriers to testing which could cause a deficit in the normalisation since they are based on denial of risk and fear on the patients{\textquoteright} side and a certain embarrassment or awkwardness to address sexual health and HIV more actively on the providers{\textquoteright} side.

The challenge lies now in the further accomplishment of the normalisation of HIV testing, with a clear focus on an efficient testing service delivery as being the starting-point of the HIV treatment cascade. For this, an improved understanding of the epidemic will provide a foundation for the development of an HIV testing model, considering the best mix of HIV testing approaches to achieve full coverage. However, for all HIV testing, the chief reason for testing must always be to benefit the individuals tested. Sufficient information should be provided to make an informed and voluntary decision to get tested whilst ensuring confidentiality and referral to appropriate follow-up services. To assure access to high-quality testing services which adhere to the guiding principles of HIV testing, the different testing approaches should be integrated within a national HIV testing policy framework. Finally, political commitment will be needed to reduce barriers to HIV testing, to support stakeholders at all levels in consolidating best practices and to expand targeted efforts within an enabling and supportive environment.},
  author       = {Deblonde, Jessika},
  isbn         = {9789078128311},
  language     = {eng},
  pages        = {VI, 123},
  publisher    = {Ghent University. Faculty of Medicine and Health Sciences},
  school       = {Ghent University},
  title        = {HIV testing in Europe : mapping policies and exploring practices in the era of increased treatment availability},
  year         = {2014},
}