Education and debate

From exceptionalism to normalisation: a reappraisal of attitudes and practice around HIV testing

^a London School of Hygiene and Tropical Medicine, London WC1E 7HT, ^b Department of Sexually Transmitted Diseases, University College London Medical School, London WC1E 6AU

Correspondence to: Professor Johnson Ajohnson@gum.ucl.ac.uk

	Introduction

Since recognition of the first cases in 1981, AIDS has been handled differently from other infectious diseases. Recently, therapeutic interventions that influence the clinical course and perinatal transmission of human immunodeficiency virus have become available.^{1 2 3} In this paper we argue that earlier and more widespread diagnosis of HIV infection will be required for these interventions to fulfil their potential.

	Origins and nature of HIV/AIDS exceptionalism

At the start of the epidemics in the United States and the United Kingdom, men who have sex with men argued when HIV/AIDS was first recognised—with the support of civil liberties groups, physicians, public health officials and others—for policies that differed from a traditional infectious disease control approach.^{3 4 5 6} This strategy has previously been termed "HIV/AIDS exceptionalism."³ Clinical confidentiality and anonymised surveillance systems were emphasised, and informed consent was strengthened. The use of HIV antibody tests, when . . . [Full text of this article]

	Recent advances in HIV/AIDS

Summary points

	Where is HIV infection diagnosed?

	Improving the detection of undiagnosed HIV infections

Pregnant women
Hospitalised patients
Other settings

	Home testing

	Public health implications of increased HIV testing

	Benefits of HIV/AIDS exceptionalism

	Conclusions

	Notes

	References

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

HIV exceptionalism must end

Martin F Brewster
BMJ 2007 335: 60. [Extract] [Full Text] [PDF]

Time to move towards opt-out testing for HIV in the UK

M Hamill, K Burgoine, F Farrell, J Hemelaar, G Patel, D E Welchew, and H W Jaffe
BMJ 2007 334: 1352-1354. [Extract] [Full Text] [PDF]

Exceptionalism in HIV

Peter Godfrey-Faussett, Rachel Baggaley, and M F Brewster
BMJ 1998 316: 1826. [Extract] [Full Text]

This article has been cited by other articles:

• Bayer, R., Edington, C. (2009). HIV Testing, Human Rights, and Global AIDS Policy: Exceptionalism and Its Discontents. Journal of Health Politics, Policy and Law 34: 301-323 [Abstract]  
• Obermeyer, C. M., Osborn, M. (2007). The Utilization of Testing and Counseling for HIV: A Review of the Social and Behavioral Evidence. AJPH 97: 1762-1774 [Abstract] [Full text]  
• Deblonde, J., Claeys, P., Temmerman, M. (2007). Antenatal HIV screening in Europe: a review of policies. Eur J Public Health 17: 414-418 [Abstract] [Full text]  
• Russell, S., Seeley, J., Ezati, E., Wamai, N., Were, W., Bunnell, R. (2007). Coming back from the dead: living with HIV as a chronic condition in rural Africa. Health Policy Plan 22: 344-347 [Abstract] [Full text]  
• Brewster, M. F (2007). HIV exceptionalism must end. BMJ 335: 60-60 [Full text]  
• Hamill, M, Burgoine, K, Farrell, F, Hemelaar, J, Patel, G, Welchew, D E, Jaffe, H W (2007). Time to move towards opt-out testing for HIV in the UK. BMJ 334: 1352-1354 [Full text]  
• Datye, V., Kielmann, K., Sheikh, K., Deshmukh, D., Deshpande, S., Porter, J., Rangan, S. (2006). Private practitioners' communications with patients around HIV testing in Pune, India.. Health Policy Plan 21: 343-352 [Abstract] [Full text]  
• Frith, L (2005). HIV testing and informed consent. J. Med. Ethics 31: 699-700 [Full text]  
• Hesketh, T, Duo, L, Li, H, Tomkins, A M (2005). Attitudes to HIV and HIV testing in high prevalence areas of China: informing the introduction of voluntary counselling and testing programmes. Sex. Transm. Infect. 81: 108-112 [Abstract] [Full text]  
• Chadborn, T R, McGarrigle, C A, Waight, P A, Fenton, K A (2004). Trends in, and determinants of, HIV testing at genitourinary medicine clinics and general practice in England, 1990-2000. Sex. Transm. Infect. 80: 145-150 [Abstract] [Full text]  
• Bassett, M. T. (2002). Ensuring a Public Health Impact of Programs to Reduce HIV Transmission From Mothers to Infants: The Place of Voluntary Counseling and Testing. AJPH 92: 347-351 [Abstract] [Full text]  
• Godfrey-Faussett, P., Baggaley, R., Brewster, M F (1998). Exceptionalism in HIV. BMJ 316: 1826-1826 [Full text]  
• Mercey, D. (1998). Antenatal HIV testing. BMJ 316: 241-242 [Full text]