All testing should include counselling

Editor - Counselling before an HIV test ensures that every patient can give informed consent for the test being done.¹ But why does HIV testing specifically require informed consent at all? Ideally, informed consent should be obtained for all medical investigations and interventions. In practice, blood is often tested for other life affecting diseases (such as tumour markers for cancers) with little discussion with the patient of the test's implications.

Pretest counselling for HIV testing includes talking about the patient's risks, the meaning of a positive or negative result, how they would cope, and what would happen if a positive result should be found. Counselling for HIV testing confers a stigma upon the disease which is detrimental to those affected by it. This stigma must dissuade many at risk patients from having a simple yet important test that could substantially prolong their life.

The doctor's duty is to investigate a patient's symptoms. If an HIV test is a rational and important investigation as part of that patient's diagnostic pathway, then that test should be done, just as you would request a chest x ray for suspected lung cancer or a carcinoembyonic antigen blood test for suspected colon cancer. And discussion about the implications of any of these tests should be equally thorough.

1. Manavi K, Welsby PD. HIV testing no longer needs special status. studentBMJ 2005;13:135. (April.)