Australia

Among gay men, the group principally affected by HIV in Australia, testing is more common than among gay men in the UK. In Sydney, 95% of gay men have tested for HIV at some time in their lives¹ and more than half have done so in the last six months.²

Australia’s 1998 testing policy was revised in 2006.³ The new policy outlines six basic principles:

• Confidential voluntary testing with informed consent is fundamental to Australia’s HIV/AIDS response.
• Testing is of the highest possible standard.
• Testing is of benefit to the person being tested.
• Testing is accessible to all those at risk of HIV infection.
• Testing is critical to understanding the epidemiology of HIV infection in the community.
• Testing is critical to interruption of transmission.

Although signs and symptoms of HIV infection are mentioned, the emphasis is on HIV testing being offered on the basis of risk factors: unprotected male-to-male intercourse, sharing of injecting equipment, having an HIV-positive sexual partner, being from a high-prevalence country, risk behaviours in a high-prevalence country, requesting PEP, or diagnosis of an sexually transmitted infection. All pregnant women should be offered the test, but uptake is in fact far from universal. This may be partly due to the low prevalence of HIV in the heterosexual population.

Pre- and post-test discussion , somewhat more comprehensive than those recommended in UK guidelines, are considered an integral part of HIV testing.

The national policy urges the development of local strategies to improve access to testing for Aboriginal and Torres Strait Islander people. Guidelines on pre- and post-test discussion may need to be adapted, to take specific issues of stigma and shame into account.

First-line diagnostic tests are usually third-generation tests.

In terms of rapid testing, quality control and quality-assurance procedures are described. The use of rapid testing should be limited to situations where a clinical decision may need to be made urgently (e.g. a person with pneumonia is suspected of having HIV infection); to rural or remote settings with difficult access to testing facilities or where patients may not return for results; and to situations where PEP is being considered. The guidelines acknowledge the possibility of using rapid tests for community-based testing projects with high-risk or hard-to-reach populations, but draw attention to problems managing the post-test discussion after a reactive result.

Both home-sampling and home-testing are rejected. The policy argues that in a low-prevalence country such as Australia, the positive predictive value of such a test will be low, and that the many false positive results will cause unnecessary anxiety.