Kudos are due just for raising this question. There are a few basics in any country, though, of course, the implications of testing vary according to the economy, health care system, life insurance policies and government policies available, to name just a couple. The basics are that individuals should only be tested following the process of informed consent, where the implications of testing are explained to patients in detail, in terms and language they will understand. It depends on your reasons for wishing to perform the test I.e. If they test positive, will the government provide long-term subsidised or free ARVs to the patients, as happens in the treatment of TB, for example? Is the test being performed to exclude people from certain jobs or will a positive result amount in nothing but negative discrimination? Has the patient requested the test or is it being performed as a  result of some government or life insurance company's directive? Thus, there is no easy solution except one -ensure you are acting primarily and solely for the benefit of the potential patient. Perhaps with a bit more information about the situation, we could discuss more specifics.

I endorse comments from Kamal in that testing must be for the benefit of the patient, not the health care professional, who should take standard precautions. In short, test when there is a reason to test, and if the patient is unable to consent, you should be able to explain to a third party why you did the test. If HIV reaches epidemic proportions, then public health measures may need to be considered, policies for which may be slightly different.

On the Indian sub-continent, guidelines for gaining consent from patients for any intervention are frequently inadequate (or not followed), with clinicians having had little or no training on how this should be done. The notion of fully informed consent is a bit of a myth, but clinicians should strive to meet the best standards possible for involving patients in decisions about their care, whether for HIV testing or anything else. The article below is recent and may help (although it doesn't directly address HIV). http://www.astrocyte.in/text.asp?2015/2/2/83/172686. Much of the literature on consent focuses on Europe and north America, but this article is specifically about India.

Roger - thanks for your response. I have visited Nepal and my MBBS and post- graduate surgical degrees are from New Delhi. Although I agree there is inadequate- to-non-existent training in medicine in India in general, despite the information level being exceedingly high in graduates from recognised institutions, I truly believe basic ethical principals are the same. It is just more difficult (though not impossible) to follow what all of us know to be the right way when we are alone in our beliefs in a given mileau. I will definately read the article you have provided with an open mind; however, I agree whole-heartedly with the sentiment you express - unless individuals stand for their moral convictions against all odds, moral progress cannot be envisaged for the future. Hence, kudos to Dr Sah! Dr. Sah - please do send us more details; we would like to support your thought process, if we can be of any help.

Thank you sir, Kamal and Roger. I am Assistant Professor in the Department of Forensic Medicine and Toxicology where I have to take the class on Ethical issues on HIV testing and I could not find any Nepal Policy or guideline on this. For this reason I have used this plateform. I will be very much glad if I could get any guidance from you two. Currently I am developing different questions for solving this issue. Soon after development of the questions, I will be sending you both also for your valuable opinions. It will be easy for me if I could get you peoples' email ID. Once again thank you so much.........

Bikash - I've sent you an email via the research gate site to reply to, if you choose.

Thank You Kamal sir......

Bikash - if you want, you can contact me on [email protected]

Roger - I read the paper you provided, thanks. I am interested to know the context within which you wrote this? Was it from personal observation, and if so, of what section of Indian medicine does it refer to? 

I am doing education policy work in India at the moment, in collaboration with the British Council, the W Bengal govt, and the National Board of Examinations. It was at an event in Delhi organised by the NBE (attended by senior clinicians from across India) that I became aware of the extent of the problems surrounding consent in India, and the NBE asked me to write this up for the journal. I have previously done a great deal on consent in the UK, including work for the GMC (plus other published articles). My observations in India were indirect in so far as they came from clinicians in a range of different specialties from public and private hospitals. There was almost no agreement on how things ought to work and what the process is meant to achieve (or is capable of achieving). Hope this answers your question and I'd be interested in your comments.

Thanks for this, Roger! Much appreciated. You are correct that there is no understanding about the ethical process whatsoever; however, the problem is much bigger and deeper. I have just sent a longer response to your gmail account. Hopefully, we can take the discussion further there...