Botswana: Update on routine HIV testing

The latest report from Botswana gives a mixed review of the policy of routine HIV testing that has been in place there since 2004. On the one hand, it is undeniable that more people are being tested in Botswana for HIV, and more of those testing positive receive treatment and care. That's good news.

At the same time, there are growing concerns about confidentiality, stigmatization, informed consent and burdens on health care staff. Predictably, there are doubts about whether the option of 'opting out' of testing is being communicated adequately, and there is the suspicion that counseling of individuals is being rushed in order to get more people tested. Members of BONELA (Botswana Network of Law and Ethics) are understandably concerned: the organization was involved in the creation of the routine HIV testing policy, on the understanding that the need for increased testing would be balanced with human rights considerations. Has the balance tipped?