Background:  Ambassador Randall Tobias, Director of PEPFAR, regularly gets tested when he visits PEPFAR countries. Ambassador Richard Holbrooke wrote recently in the Washington Post about the important place of HIV voluntary counseling and testing (VCT) in prevention and care. He wrote that many excoriated him for advancing HIV VCT, indicating that evidence for its efficacy and utility are limited.

Methods and Results:  This presentation will first review the evidence supporting the utility of HIV VCT in reducing HIV risk behaviors and preventing HIV transmission among HIV⁺ and HIV^­ individuals and couples, both in the developed and developing worlds. It will then present and discuss data on barriers to HIV VCT, especially in resource-poor countries. The implications of such information for improving HIV VCT services, especially among high-risk populations, will be discussed. Data will also be presented on barriers to testing for high-risk individuals and persons needing ART or programs focusing on prevention of mother-to-child transmission. Advances in HIV VCT technology (eg, rapid testing, home-based testing) will be presented, with their implications for prevention and access to care. The presentation will also discuss the tension between the public health objectives of testing and concerns about human rights violations in testing, with a special emphasis on opt-in vs opt-out testing. 

Conclusions:  The presentation will conclude with ongoing and needed research in HIV VCT, with an emphasis on the tension between the preventive and diagnostic aims of HIV VCT, and the kinds of research needed to resolve and eliminate such tension.