UNFPAReproductive Health in Refugee Situations: An Interagency Field Manual
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Annex 1
HIV Testing in Refugee Situations

HIV Testing in Refugee Situations Available resources for HIV testing should be devoted, first and foremost, to ensuring a safe blood supply for transfusions. A voluntary HIV testing and counselling (VCT) programme is a lower priority in a refugee situation but should not be ruled out if resources are available and if these services are available in the host country or were available in the country of origin.

HIV testing to diagnose HIV-related illness may be indicated, but only if two conditions are met:

  • consent, pre-and post-test counselling and confidentiality can be assured; and

  • a confirmatory testing procedure is undertaken as outlined in UNAIDS Policy on HIV Testing and Counselling.

People known to be HIV infected or to have AIDS should remain within their communities or within the refugee settlements, where they should have equal access to all available care and support.

UNAIDS/WHO Position on Mandatory HIV Testing in Refugee Situations

Mandatory HIV testing in refugee circumstances, with the single exception of testing blood for transfusion, is not justified. WHO and UNAIDS have determined that such testing should not be pursued as a matter of policy.

  • Identifying people with HIV/ AIDS through mandatory testing does nothing to stop the spread of the virus.

  • Mandatory testing is a violation of human rights, and it leaves those who are identified as HIV-positive open to discrimination and persecution.

  • No negative HIV test can be assumed to have excluded the possibility of HIV infection in the person tested. There is a latent period of several weeks following infection, during which the HIV test can come up negative, but the person is still capable of transmitting the infection through unprotected sexual contact or blood. Occasionally, too, tests have shown false negative results.

  • A negative HIV test offers no assurance that the person tested will not be exposed to HIV and become infected soon thereafter.

  • A negative HIV test is, therefore, no reason to relax the universal precautions that health workers need to observe at all times; nor does a negative HIV test give any reason to feel that sterile procedures during medical interventions are any less important. In practice, every patient should be regarded as a potential carrier of HIV, Hepatitis B or other blood-borne infections, since testing removes none of the potential for transmitting these diseases.

  • UNHCR and International Organization on Migration (IOM) issued a joint policy in 1990 which strictly opposes the use of mandatory HIV screening, and any restrictions based on a refugee's HIV status. Nevertheless, some States have adopted mandatory HIV testing for refugees and exclude those who test positive. Other States place restrictions on the admission of persons whom they know to be HIV positive or have AIDS. Although some countries have established waiver procedures, resettlement cases of refugees who are HIV positive or have AIDS are certain to be more complex than most resettlement cases.

  • Resettlement considerations of refugees living with HIV are difficult and must be given special attention to avoid placing these persons at greater risk for discrimination, refoulement, and institutionalisation.