Evidence map›Paper›PMID 41398580›Full record

ReviewBMC public health2025

From exceptionalism to universal testing: an historical review of HIV testing in Portugal.

Raul Manarte, Margarida R Henriques

Abstract readHistorical ArticleReview
In one paragraph

Review in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors.

Raul ManarteFPCEUP - Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal. raulmanarte@gmail.com.
Margarida R HenriquesFPCEUP - Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPortugal has made significant progress over the last 40 years in the response against the Human Immunodeficiency Virus (HIV) infection and the Acquired Immunodeficiency Syndrome (AIDS). However, as of 2021, it remained one of the three Western European countries with the highest rates of new HIV infections and AIDS cases. Initially shaped by HIV exceptionalism, Portugal began transitioning to a universal testing strategy in 2011. This study provides a historical and policy review of the evolution of HIV testing in Portugal, focusing on alignment with international guidelines and national implementation outcomes.

methodsWe conducted a narrative policy review covering the period from 1998 to 2024. Our analysis drew on scientific literature, national health plans, surveillance reports, and international guidelines. Documents were selected through structured searches in multiple academic databases and government repositories using relevant Portuguese and English search terms. Thematically coded findings were mapped chronologically and assessed against evolving WHO and CDC recommendations.

resultsPortugal gradually moved from a targeted testing approach to a more comprehensive, universal strategy. Key policy shifts occurred in 2011 and 2017, accompanied by an expansion of testing modalities, including self-testing and community-based testing. Despite these developments, implementation has been uneven. The lack of standardized protocols, limited integration into primary healthcare, and regional disparities tied to a contract-based health system have contributed to inconsistent service delivery. Additionally, testing uptake among older adults, migrants, and other key populations remains suboptimal. The COVID-19 pandemic temporarily disrupted testing services but also accelerated the use of self-testing strategies. DISCUSSION: Portugal's experience illustrates the challenges of operationalizing universal HIV testing within a hybrid public-private healthcare system. Although policies increasingly reflect international best practices, structural barriers continue to hinder equitable implementation.

conclusionTo close existing testing gaps, Portugal must strengthen implementation by standardizing procedures, improve disaggregated data collection in monitoring systems, and ensure greater integration of HIV testing in primary healthcare. Enhanced outreach to underserved populations will be critical to achieving national and international HIV prevention targets. This paper offers a historical and policy perspective to inform more equitable and effective national testing strategies.

Indexed as

Health PolicyHIV InfectionsHIV TestingMass ScreeningUniversal Health CareHistory, 20th CenturyHistory, 21st CenturyHumansPortugalHistorical reviewHIV counselingHIV preventionHIV testingPortugalPublic health policy

Identifiers

PMID41398580
PMCPMC12706945

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.