These guidelines replace CDC's 1994 guidelines, HIV Counseling, Testing, and Referral Standards and Guidelines, and contain recommendations for public-and private-sector policy makers and service providers of human immunodeficiency virus (HIV) counseling, testing, and referral (CTR). To develop these guidelines, CDC used an evidence-based approach advocated by the U.S. Preventive Services Task Force and public health practice guidelines. The recommendations are based on evidence from all available scientific sources; where evidence is lacking, opinion of "best practices" by specialists in the field has been used. This revision was prompted by scientific and programmatic advances in HIV CTR, as well as advances in prevention and the treatment and care of HIV-infected persons. These advances include a) demonstrated efficacy of HIV prevention counseling models aimed at behavioral risk reduction; b) effective treatments for HIV infection and opportunistic infections; c) effective treatment regimens for preventing perinatal transmission; and d) new test technologies. Although the new guidelines include many aspects of the previous ones (e.g., encouragement of confidential and anonymous voluntary HIV testing, need for informed consent, and provision of HIV prevention counseling that focuses on the client's own risk), the new guidelines differ in several respects, including - giving guidance to all providers of voluntary HIV CTR in the public and private sectors; - using an evidence-based approach to provide specific recommendations for CTR; - underscoring the importance of early knowledge of HIV status and making testing more accessible and available; - acknowledging providers' need for flexibility in implementing the guidelines, given their particular client base, setting HIV prevalence level, and available resources; - recommending that CTR be targeted efficiently through risk screening and other strategies; and - addressing ways to improve the quality and provision of HIV CTR.# INTRODUCTION

# Purpose of the Guidelines
These guidelines were developed for policy makers and service providers in the many settings that offer voluntary human immunodeficiency virus (HIV) counseling, testing, and referral (CTR) -public and private, urban and rural, and those with high and low HIV prevalence (Box 1). The guidelines are intended to be used to develop CTR services and policies in traditional clinical settings (e.g., sexually transmitted disease ), which can be important places to provide access to CTR to persons at increased HIV risk. The Public Health Service is responsible for ensuring the quality of services in publicly funded programs, and many aspects of these guidelines focus on such programs. The guidelines could also be useful for CTR in other settings (e.g., for insurance, military, and blood donation purposes).
Recommendations should be tailored to fit the needs of clients, communities, and programs within local, state, and federal rules and regulations.

# Evolution of the Guidelines
These guidelines revise and update several sets of CDC guidelines for HIV CTR. The first CDC guidelines, published in 1986, highlighted the importance of offering voluntary testing and counseling and maintaining confidential records (1 ). In 1987, new guidelines emphasized the need to decrease barriers to counseling and testing, especially disclosure of personal information (2 ). In 1993, an additional report described the model of HIV prevention counseling currently recommended -an interactive rather than didactic model focusing on a personalized HIV risk-reduction plan (3 ). In 1994, HIV Counseling, Testing and Referral Standards and Guidelines focused on standard counseling and testing procedures and reiterated the importance of the HIV prevention counseling model and the need for confidentiality of counseling (4 ).
- Publish electronically and in hard copy. Single copies of this report are available from CDC's National Prevention Information Network (NPIN) website at  or by calling (800) 458-5231. The guidelines are also available at the HIV Counseling, Testing, and Referral website at . They will be updated and posted periodically.

# Similarities and Differences Between Current and Previous Guidelines
Aspects of previous CDC HIV guidelines that are unchanged include
- encouraging availability of anonymous as well as confidential HIV testing;
- ensuring that HIV testing is informed, voluntary, and consented;
- emphasizing access to testing and effective provision of test results;
- advocating routine recommendation of HIV CTR in settings (e.g., publicly funded clinics) serving clients at increased behavioral or clinical risk for HIV infection;
- recommending use of a prevention counseling approach aimed at personal risk reduction for HIV-infected persons and persons at increased risk for HIV; and
- stressing the need to provide information regarding the HIV test to all who take the test.

# MMWR November 9, 2001
Differences in the new guidelines include
- giving guidance to all providers of voluntary HIV CTR in the public and private sectors;
- using an evidence-based approach to provide specific recommendations for CTR;
- underscoring the importance of early knowledge of HIV status and making HIV testing more accessible and available;