Advance directives and the National Health Act.

Abstract

testing opportunities. The ‘exceptionalisation’ of HIV testing developed during an earlier period of therapeutic nihilism when the disadvantages of testing were thought to exceed the benefits of testing. A positive HIV diagnosis was known to impact negatively on quality of life 15 but the therapeutic benefits accruing from knowledge of HIV status were limited and the preventive epidemiological benefits were undefined. The risk/benefit ratio of HIV testing began to change with increasing access to the benefits of co-trimoxazole prophylaxis 16 and prevention-of-mother-to-child transmission (PMTCT) services. Access to antiretroviral therapy further increases the survival benefits conferred by knowledge of HIV-positive status. 17 The benefit of increased population HIV testing by decreasing sexual risk behaviour has been demonstrated in the USA 2 and other countries 5 but has yet to be clearly shown within South Africa. Normalising HIV testing as part of routine medical care may also serve to reduce the stigma of HIV infection. As the benefits of HIV testing increase at an individual and population level, so HIV testing strategies need to evolve. The challenge we face is to maximise the benefit dividend of effective HIV treatment while maintaining confidentiality and protecting human rights. Introduction of universal ‘opt-out’ HIV testing in all South African health care facilities may allow an opportunity to fulfil the individual right to the highest level of health and have public health benefit by impacting on prevention at a population level. 1. Centers for Disease Control. Cases of HIV infection and AIDS in the United States, 2004.