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The plan to increase HIV testing is a cornerstone of the international health strategy against the HIV/AIDS epidemic, particularly in sub-Saharan Africa. Using material form ongoing demographic research project conducted in three rural areas of Malawi, this paper highlights a problematic aspect of that plan: the reliance on clinic- rather than home-based testing. It asks if home-based opt-in testing is the answer to contemporary testing problems?

The paper demonstrates the substantial differences in socio-demographic and economic profiles between those who report having ever had a clinic-based HIV test, and those who report never having had one. In this context, it reveals that those who have had a clinic-based HIV test tend to be wealthier, more educated, and less likely to be currently married.

The paper concludes that  there are strong indications that home-based Voluntary Counseling and Testing (VCT) can equalize access to testing across socioeconomic strata, marital status, or any other social characteristics that typically affect clinic use, namely:

• in addition to dramatically increasing HIV-testing prevalence, home-based testing is also associated with marked reductions in inequalities in the profile of testees
• removing the variation in social characteristics from HIV testing is a crucial first step to reducing health-systems' inequitable practices
• it is also a crucial first step in stopping such systems from re-producing contemporary inequalities by characterising differential future patterns of infection and mortality
• it is the only way to enact a testing policy which takes advantage of the fact that the poor and ill-educated, while less likely to come to clinics, are no less willing to have an HIV test

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