When should HIV screening be offered in primary care, and what consent considerations apply?

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Offering HIV screening in primary care as a routine opt-out test is the approach that best fits current practice. In this model, patients are informed that an HIV test will be done unless they decline, which helps normalize testing, increases screening rates, and supports early detection. Central to this is careful handling of consent and confidentiality: patients should understand what the test involves, what the results could mean, and who will have access to their information, with a clear option to decline. Counseling should also cover the window period—the time after a possible exposure when the infection may not yet be detectable—so patients understand why a negative result soon after exposure might not rule out infection and why a retest after the window period may be appropriate. Testing only upon patient request misses many cases, confidentiality is required, and the window period can affect testing decisions.