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I think the opt-out system of HIV testing is a fairly good idea. Of course, it will have to be looked at carefully, and checks put in place to ensure confidentiality and avoidance of stigma. That is something I am not sure South Africa is ready for, but I'm also not sure that it isn't ready for it. Many of my patients have suffered from faulty bigoted public perceptions of HIV and AIDS. But only by attempting progress can we find out whether an opt-out system would change that for the better or the worse.
My HOD sent me these links ... I hadn't seen them before. They deal with this issue. Also see the article by Judge Edwin Cameron elsewhere on my blog.
Testing stigma - 16 May 2006, Mail & Guardian
One critic of Cameron's approach is Mark Heywood of the Aids Law Project, who said that while people should be encouraged to test for HIV, Cameron was "trying to de-exceptionalise, when HIV remains an exception. For most people, HIV diagnosis remains full of dangers and access to treatment is far from guaranteed."
HIV: pre-test counselling 'a luxury' - 17 August 2006, Mail & Guardian
"Where the right conditions exist, we should therefore re-medicalise the diagnosis of HIV, by making it a normal part of medical treatment, subject only to a patient's deliberate and express refusal to be tested."
We may well be witnessing a change in the approach to HIV testing here in South Africa.