Table 2. Changing patterns in HIV testing, counseling, and clinical services from 2001 to 2006 (N = 90). HIV Services in India Labs in 2001 (Mean, %) Labs in 2006 (Mean, %) (N = 90) (N = 90) p-value 40.0 13.3 72.2 91.1 8.9 20.0 23.3 42.2 36.7 16.7 22.3 34.4 15.6 14.5 31.1 21.1 30.0 32.2 6.7 5.5 75.6 5.6 56.7 21.1 HIV Testing Services HIV diagnostic tests offered by labs ELISA Western blot Tridot Job related Migration Reasons clients sought STD/HIV testing Number of HIV tests performed in a month Males who came for HIV testing in the last month Females who came for HIV testing in the last month Number of HIV tests that were physician referred ,5 6–10 .10 ,5 6–10 .10 ,5 6–10 .10 ,5 6–10 .10 ,5 6–10 .10 Number of tests that were walk-ins HIV Referral Services Source of physician referrals Physicians in the same area Physicians from elsewhere HIV Counseling Services Lab provided pre-test counseling doi:10.1371/journal.pone.0003471.t002 Client referred to physician or institution when testing positive for HIV migratory reasons, as both reasons provide documentation necessary for Indians to seek work overseas. Currently, there is no mandatory HIV testing for domestic employment neither in the Indian public nor private sectors. However, the Gulf States, which have a large number of South Asian nationals working as guest workers, have required mandatory HIV testing of all foreign nationals since the 1990s [26,27]. Before being granted a resident permit, foreign nationals entering the Gulf States are tested in their country of origin. The reasons individuals sought VCT services at the private labs in this study differed from prior self-report studies at YRG CARE, which found that the major reason men sought testing was due to risk behavior and HIV-related symptoms and the major reason for women was a HIV-seropositive partner [19,28]. Based on the current study, individuals utilizing HIV testing at these labs are not seeking these services due to their own risk profile or symptoms, but due to immigration requirements. New approaches to testing and accessing at risk individuals must be developed before HIV infected individuals report with opportunistic infections for clinical care. Fewer labs in 2006 referred their clients testing positive for HIV to external physicians or institutions than in 2001. It is likely that more private labs provide in-house HIV care and treatment at affiliated institutions, however studies have shown that private Indian institutions may lack adequate training in providing HIV services [29,30]. Additionally, less than a tenth of labs were interested in training lab personnel in counseling, while in 2001, over half the labs were interested in training lab personnel. By 2006, an increasing proportion of labs may have developed their PLoS ONE | www.plosone.org 4 October 2008 | Volume 3 | Issue 10 | e3471 100.0 87.8 84.4 98.9 70.0 27.8 16.7 20.0 31.1 5.6 10.0 79.0 4.4 10.0 78.9 20.0 8.9 14.4 52.2 37.8 40.0 34.4 ,0.001 ,0.001 ,0.001 ,0.001 ,0.001 NS 0.006 ,0.001 0.034 ,0.001 0.025 0.046