The challenges of testing for HIV in women: experience from the UK and other European countries.

Strategies for HIV testing vary across Europe, but widespread unacceptably high rates of late diagnosis among women suggest that current testing strategies are not adequately reaching the female population. The only group within the female population that is given specific consideration in guidelines for HIV testing is women who are pregnant, where opt-out testing is often recommended. This article reviews experience from the UK and other European countries with antenatal testing, and trials of routine HIV testing in a range of other settings. Further recommendations for testing strategies for women are required, but need to consider physician barriers to testing, such as constraints on time and training. It is vital to evaluate the motivations that underlie a woman's decision to accept or refuse testing, as these often differ from those of men. Similarly, the consequences of a positive diagnosis for a woman need to be addressed in pre- and post-test discussions.