Voluntary Counseling and Testing

Monday, March 17, 2008

Afro-Arab youth shun HIV testing

By, Barbara Among and Anthony Bugembe, New Vision, March 16, 2008

Delegates attending the Afro-Arab youth conference have shunned testing for HIV due to cultural biases and lack of awareness.

Those from the Arab world told the medical personnel that their culture did not allow promiscuity therefore, they believed they were HIV negative.

Sex is also a private issue which should not be discussed with strangers or in public, they added.

An Egyptian female delegate argued: “The decision to test for HIV has to be taken by my husband.”

According to a counsellor from the Straight Talk Foundation, Resty Nabwire, Arab delegates only took literature on HIV/Aids.

During the two-day HIV campaign last week, only 101 delegates, of which the majority were from Uganda and Kenya, tested for the AIDS virus. Two Ghanains and Libyians also participated.

Poor organisation was also to blame for the low turn-up.

Straight Talk complained that they were not allocated a place to operate from in time.

“We were supposed to be here right from the beginning to the end of the conference, but that didn’t happen. Even for the two days (Wednesday and Friday), the tents were only provided after 2:00pm,” Nabwire said.

Source: http://www.newvision.co.ug/D/8/13/616995

Tuesday, August 14, 2007

HIV test targets 'will be missed'

Too many people are refusing HIV tests at sex health clinics - and a key government target could be missed as a result, says an Aids charity.
The target aimed to halve the number of people whose HIV infection is missed when they visit a sexual health clinic for another reason.

The National Aids Trust said that making an HIV test automatic could solve the problem.

The Department of Health said it was reviewing policy on testing.

Many people who have contracted HIV remain unaware of this, as it may be some time before symptoms begin to appear - it is estimated that a third of HIV-positive men and women in the UK don't know they have the virus.

However, during this period, they may be able to pass the virus on to others through unprotected sex or sharing drug needles.

The government's National Strategy for Sexual Health pledged, by the end of this year, to cut by 50% the proportion of people infected with HIV who remain unaware of their infection even after a visit to a sexual health clinic for another reason.

Experts can work this out because the Health Protection Agency tests random, anonymous blood samples, even where the patient has refused an HIV test, providing a figure for the underlying rate of infection among people visiting clinics.

Opting in

In 2001, 55% of gay men with undiagnosed HIV visited a sexual health clinic, and left without a diagnosis.

It is vital that people living with HIV are diagnosed as early as possible

Deborah Jack, National Aids Trust

In the latest figures taken in 2005, this had fallen to 43%, well short of the target of 27.5%.

The target is likely to be met among heterosexual patients, with the figure falling from 48% in 2001 to 27% by the end of 2005.

At the moment while people are offered and encouraged to take an HIV test, unless they actively "opt in", the test won't take place.

The National Aids Trust now wants an "opt-out" system for HIV testing, with the presumption that the test will go ahead unless the patient actively refuses.

Deborah Jack, Chief Executive, said: "It is vital that people living with HIV are diagnosed as early as possible, both for the sake of their own health and to prevent the virus being passed on.

"It is estimated that there are 20,000 people with HIV in the UK who have not yet been diagnosed.

"Making an HIV test a routine part of a sexual health check-up could really help reduce those numbers, particularly among gay men."

Policy review

By, BBC News, August 10, 2007

Nick Partridge, Chief Executive of the Terrence Higgins Trust supported the call: "Routine HIV testing in sexual health clinics is both appropriate, cost effective, and long overdue.

A spokesman for the Department of Health said that there had been "encouraging progress" among heterosexual men and women visiting clinics.

He said: "The Department is currently working with the Expert Advisory Group on Aids and others including the Terrence Higgins Trust, to review our policy on HIV testing in sexual health clinics.

He added that it was important that, even if an opt-out system was introduced, that proper consent was obtained from patients.

Source: http://news.bbc.co.uk/2/hi/health/6940326.stm

Friday, July 27, 2007

More older people seeking anonymous HIV testing: report

By, Channel NewsAsia, July 26, 2007

Singapore: More older people are seeking anonymous HIV testing at clinics here - a departure from common perception that only the younger and better-educated seek verification.

This is according to findings reported on HIV testing at a conference for General Practitioners on Thursday.

The rapid HIV test kit by Singapore-based biotech company Rockeby Biomed was approved by the Ministry of Health (MOH) last May.

It uses one's saliva, and promises anonymity... so only you and your doctor know the results.

Perhaps this was what attracted close to 700 people to come forward since the test kit was tried out at two GP clinics a year ago.

Most are single, heterosexual and more than half are professionals or managers.

Nine in 10 are below 40 years old.

But the number of those above 40 has almost doubled in the past few months.

Dr Chua Thiam Eng, General Practitioner, Cambridge Clinic, said: "One or two of these elderly gentlemen who come in... usually they go to Batam. Not many of them, but the good thing is we're seeing them already - one or two, compared to when we first started. It's all those educated professionals who are well-informed."

Doctors say more should be done to educate the public, especially blue collar workers.

But at least anonymous testing is off to a good start.

So far, the pilot programme has picked up eight positives, almost twice the 0.5 per cent detection in general population blood sampling.

Dr Tan Sze Wee, CEO, Rockeby Biomed, said: "This group of patients who came forward for HIV testing would probably be the high risk group. And as you can see, if you have a good programme there, they definitely do come forward.

"I think this is probably a very good programme for them to be tested early. What's most important at the end of the day is reducing the barriers of testing."

The MOH says it is planning to allow the use of rapid HIV test kits at all medical clinics, and may also introduce them in non-clinical locations. - CNA/yy

Source: http://www.channelnewsasia.com/stories/singaporelocalnews/view/290541/1/.html

Monday, July 23, 2007

Malawi Unveils Mass HIV Testing Campaign - Report

By, ABC News, July 23, 2007

JOHANNESBURG - Health officials in Malawi were preparing on Monday to launch a massive HIV testing programme to identify tens of thousands of people unknowingly infected with the virus in the southern African nation.

Many of the estimated 14 percent of Malawian adults who are HIV-positive do not know they are infected, jeopardising efforts to stop the spread of the HIV/AIDS epidemic among sexually active teenagers and adults, the government has said.

Malawi hopes to administer voluntary HIV tests to some 130,000 people this week, according to its health department, which estimated only 1 million of Malawi's 6 million sexually active population knew their HIV status.

"This implies that the majority of Malawians do not know that they are carrying the virus because they have not gone for a test, a situation that poses a great threat to prevention efforts," health authorities said in a statement, according to South Africa's SAPA news agency.

Malawi has already lost an estimated 1 million people to AIDS since the disease first surfaced in the 1980s, straining its tiny health-care system and devastating agricultural production, the lifeblood of the local economy.

The impoverished nation continues to struggle to find enough money to put in place grassroots HIV-prevention efforts, especially in rural areas where HIV infection rates are still rising, in contrast to the declines seen in cities.

Close to 30,000 newborns are infected every year because of the government's failure to prevent mother-to-child transmission, and only a fraction of those living with HIV have access to life-saving anti-retroviral drugs, according to officials.

But AIDS activists have praised Malawi for its hands-on approach to fighting the disease, noting that it was one of the first nations in sub-Saharan Africa to implement a regular national HIV testing programme.

Source: http://abcnews.go.com/International/story?id=3380965&page=1

New guidance on recommended HIV testing and counselling

By, The Lancet, July, 2007

After a series of meetings, open internet-based reviews, and consultations over a year, WHO and UNAIDS recently released guidance on HIV testing and counselling initiated by health providers.1 Those not engaged in this exercise might not fully appreciate the evolution of thinking represented by this final document, nor the role played by active debate between constituencies with diverging views on key issues. Among these issues was whether HIV testing should be included in the panoply of routine tests given in health settings on the initiative of the clinician, unless the patient specifically opted-in by asking to be tested for HIV or opted-out by refusing the test, despite not having been prompted to consent to it. Many found the ideas confusing2–4 and questioned the underlying assumption of this approach—ie, that patients who signed off on admission forms when consulting or being admitted to a care facility de-facto agree to any diagnostic test found necessary by the treating doctor. Concerns were raised that, unlike other tests, in view of prevailing stigma, discrimination, and risks of violence attached to an HIV-positive result in many settings, particularly for women, specific individual agreement to the test remained necessary.5,6

As the WHO/UNAIDS guidance evolved towards its now final form, despite some reference to opting-in and opting-out, liberal use of this language was dropped and replaced with ideas more reflective of sound public health, medical ethics, and human rights. Specifically, the ambiguous notion that providers would initiate testing (with lack of clarity about whether this testing is with or without expressed consent) has shifted to a model in which providers recommend testing (thus proceeding with the test only after consent has been given by the patient). The WHO/UNAIDS guidance continues to use the term provider-initiated testing, but provider-recommended testing is now what the guidance advocates. The crucial difference here is that doctors are now encouraged to recommend a test, and not simply to test without securing the patient's specific agreement. In many ways, the WHO/UNAIDS document is far clearer and better anchored in evidence than the rather confusing 2006 guidelines of the US Centers for Disease Control and Prevention (CDC), to which it refers supportively several times.7 The CDC guidelines use terms inconsistently, and thereby create (deliberately or not) a wide space for doctors to do HIV tests on patients with or without express consent. The strength of the WHO/UNAIDS document lies in its attention to specific elements to be considered when formulating or reformulating HIV-testing policies according to various environments, epidemic types, health settings, clinical presentations, and testing practices. Yet, several issues will require attention while this guidance is implemented, including the rather vague approach to monitoring and evaluation, even as WHO is under stress to anchor its guidelines more strongly in evidence.8 Critical indicators, sources of information, and means of measurement could have been suggested to set groundwork for risk-management and further revisions of this guidance. The more-than-elusive description of how the guidance is to be adapted to specific country settings is another area that needs attention. This description will require rapid pre-emptive measures by WHO/UNAIDS and others, such as development of methods to facilitate adaptation process, failing which adaptation might go astray on the initiative of those who believe that widespread HIV testing is an effective response to the epidemic. A further issue is the lack of reference to how this form of testing will intersect with the trend towards criminalisation of HIV transmission,9 in particular when a previous record of a positive HIV test could be interpreted to mean that a person knowingly transmitted HIV to others, whether deliberately or negligently.

Policymakers may now opt-in to the guidance and model policies, and practice can proceed along the lines proposed, even though there will be substantial differences in how this change is made. Some policymakers will no-doubt opt-out, holding that the guidance is insufficient and does not respond to local realities. Clinicians, other health practitioners, and civil society will have to be vigilant in their attention to the uses and abuses of HIV-testing policies as the policies are reformulated and, just as importantly, to the observed gaps between public-health goals, policy, and practice.

Source: http://www.thelancet.com/journals/lancet/article/PIIS0140673607611027/fulltext?rss=yes

Friday, July 20, 2007

Should AIDS testing be mandatory?

By, Tan Hui Leng, Channel News Asia, July 20, 2007

Amid startling statistics that one in 350 hospital patients are HIV-positive, at least one voluntary welfare organisation here has called for mandatory testing of high-risk groups, in what some have described as a highly controversial and intrusive move.

The group — Focus on the Family — said it would be submitting a proposal, drafted together with doctors, to the Ministry of Health (MOH) soon.

High-risk groups, such as men who visit sex workers and sexually-active gay men, should go for compulsory testing, said its director, Mr Tan Thuan Seng.

"We should not allow people who choose high-risk lifestyles to avoid testing and thereby subject innocents in their households and medical workers to unfair risks of infection," said Mr Tan.

"These undiagnosed infected are walking time-bombs as they have the potential to knowingly or unknowingly infect others."

On Tuesday, it was revealed that a recent MOH study of over 3,000 anonymous blood samples collected in hospitals showed that 0.28 per cent of those who thought they were free of the disease were in fact HIV-positive.

This was followed by the news that the MOH is investigating the case of a man suspected of spreading the virus knowingly.

However, MPs and AIDS volunteers TODAY spoke to were concerned about how the identification of such HIV-positive carriers is intrusive and stigmatises those affected.

"In implementing it, it's hard to not intrude into the privacy and rights of individuals," said chairman of the AIDS Business Alliance, Mr Zulkifli Baharuddin.

Mr Benedict Jacob-Thambiah, an Action for AIDS volunteer and the programme director of Heat Consultants, which provides HIV education at the workplace, agreed.

"Mandatory testing of any group only serves to stigmatise, isolate and deepen discrimination. It is not something I would advocate as I do not think any Singaporean should be subject to something that is patently wrong. It does no one any good," he said.

Since December 2004, pregnant women have been subjected to opt-out HIV tests as part of standard antenatal screening here. Only one case of mother-to-child transmission has occurred, and that was because the mother refused her HIV test until very late in her pregnancy, according to the MOH.

Last year, Singapore experienced a record high of 357 new HIV-positive cases.

Making testing compulsory — even for small high-risk groups — could pose some implementation problems, said deputy chairman of the Government Parliamentary Committee for Health, Dr Lam Pin Min.

"It's hard to identify persons in the high-risk groups unless they declare it themselves," he said. "It also makes it very difficult to draw a line on whether you visit sex workers or are sexually liberal or promiscuous.

"So, if you make it a law to self-declare, does it mean that you're breaking the law if you're in one category or the other?"

Those TODAY spoke to were all in favour of better public education, particularly as the HIV/AIDS situation here is not seen as dire.

"I don't think the situation has come to the point where there is a real epidemic that requires an intrusion into private lives," said AIDS Business Alliance chairman Zulkifli. "We always try to persuade and cajole people, and, in most cases, they respond."

Source: http://www.channelnewsasia.com/stories/singaporelocalnews/view/289282/1/.html

Mandatory HIV testing will backfire

By, Bobby Ramakant, The Correspondent, May 3, 2007

"Testing for HIV is more than a mere biological test"

Last month, India's Karnataka State proposed mandatory HIV testing for couples. This month, Andhra Pradesh State suggested mandatory testing before marriage following a similar move by Goa in April 2006.

But will mandatory HIV testing alone reduce the rate of new infections? Public health experts and advocates say it won't.

"We need to raise awareness about HIV, reduce stigma associated with HIV, especially stigma within health-care settings (which keeps people away from accessing these services) …, strengthen primary healthcare services and raise sensitivity to the issues of confidentiality and dignity of life of those living with HIV," said noted health care rights advocate Jashodhara Dasgupta of SAHAYOG and Health Watch.

The progress we have made towards integrating HIV prevention and treatment is at risk of being lost if Indian states start promoting HIV prevention strategies while completely ignoring the need to treat, support and care for people living with HIV (PLHIV).

But Andhra Pradesh Chief Minister Y S Rajasekhar Reddy was quoted by Rediff News on 17 April as saying, "I fail to understand the reasons behind the objections raised by some human rights activists on the government's initiative for making HIV/AIDS tests mandatory for couples before marriage."

India is at a new crossroads in HIV control with serious divisions emerging between the promoters of mandatory testing and the supporters of voluntary options.

Human rights advocates warn Dr Reddy that the impact of a positive HIV diagnosis on an individual's life is enormous. The stigma, discrimination and denial often associated with an HIV positive status can affect a patient in many ways.

What programmes are there for people who test positive? Will they be left to face life without access to even primary health care services?

As we prepare to complete disregard the confidentiality guidelines of the National AIDS Control Organization (NACO) and allow information on the HIV positive status of potential brides and grooms to be shared among their communities, are we prepared to meet the health care needs of the people who test positive? And are we prepared to ensure that they will not be forced to lead a life adversely affected by stigma, discrimination and denial?

An official from the Joint United Nations Programme on HIV/AIDS (UNAIDS) has said that India needs to consider the fact that mandatory HIV testing may prove to be counter-productive as it violates a patient's right to privacy, stigmatizes whole families and "tends to create a black market in false HIV test results."

Senior Advocate Colin Gonzalves has also argued that "any mandatory testing is wrong. Couples should rather be counselled and educated," adding that, "If they want to get a testing done by choice after that, it's their business. But a mandatory test can't be imposed on them".

NACO guidelines add that, "Testing for HIV is more than a mere biological test for it involves ethical, human and legal dimensions. The government feels that there is no public health rationale for mandatory testing of a person for HIV/AIDS. On the other hand, such an approach could be counter productive as it may scare a large number of suspected cases from getting detected."

HIV testing alone does not result in the types of behavioural changes that will prevent the transmission of the virus. It should be an integrated part of comprehensive control programmes that promote behavioural change by providing social support and the means and skills to reduce or eliminate the risk of transmission. "Otherwise such testing can drive the target people underground and make it more difficult for launching intervention," according to one NACO official.

As access to antiretroviral treatment increases, we have the opportunity to simultaneously expand access to HIV prevention programmes, which continue to be the mainstay of the response to the HIV epidemic. Without effective HIV prevention, increasing numbers of people will require treatment. Among the intervention methods that play a pivotal role in both treatment and prevention, HIV testing and counselling stand out as paramount.

The current reach of HIV testing services remains poor. The reality is that stigma and discrimination continue to discourage people from being tested. To address this, HIV testing programmes must include improved protection from stigma and discrimination, especially within the health care setting, as well as assured access to integrated prevention, treatment and care services.

Earlier this month, a pregnant woman with HIV died after being denied medical attention in Indore. It is clear that India has a long way to go before it has a public health system strong enough to deliver effective health care to the most under-served communities. Mandatory HIV testing alone will certainly not provide a short-cut.

Source: www.thecorrespondent.org

Uganda: IDPs Test for HIV/Aids

By, Chris Ocowun, New Vision (Kampala), July 15, 2007

Thousands of internally displaced persons (IDPs) living in camps and in Gulu town turned up for an open-air voluntary counselling and testing as part of the activities to mark the World Population Day.

Mothers, with their babies, attended antenatal services and reproductive health education offered by the Family Planning Association, the United Nations Population Fund, Gulu Youth Centre and Uganda AIDS Commission.

The United Nations Fund for Population Activities national associate, Brian Kironde, told journalists that they would open youth corners in health centres in five districts including Gulu.

The youth will access free adolescent services.

"Youths should be given adolescent services without judging and asking them many questions. They should be able to get condoms without signing for them," he stated.

He said the open-air voluntary counselling and testing and sensitisation on family planning methods started on Sunday in Patiko-Ajulu camp.

"We tested more than 200 youths and 250 others were tested at Awach camp on Monday. We had overwhelming response from the residents of the IDP camp. It was encouraging and this showed us that they need the services," Kironde said.

He added that many children below 10 years thronged the counselling venues demanding to be tested for HIV/AIDS.

Kironde said they met the camp leaders and urged them to mobilise and sensitise parents about the friendly services.

The theme for this year's Population Day celebrations in Gulu was "Involving men as active partners in maternal health."

Source: http://allafrica.com/stories/200707160618.html

Friday, June 15, 2007

New HIV testing guidance out

By, myjoyonline.com, June 14, 2007

The World Health Organisation (WHO) in collaboration with UNAIDS have issued new guidance on Voluntary HIV testing and counselling in all health facilities throughout the world.

The new guidance focuses on provider-initiated HIV testing and counselling as recommended by health care providers in health facilities.

The new WHO/UNIADS guideline was prepared in light of increasing evidence that provider-initiated testing and counselling could increase uptake of HIV testing, improve access to health services for people living with HIV and create new opportunities for HIV prevention.

This was contained in a document by WHO and made available to the Ghana News Agency in Accra on Thursday.

It advised that all health care providers globally recommend HIV testing and counselling to people who were presented with conditions that might suggest underlying HIV.

The document noted that the new approach would increase access to the needed HIV treatment, care, support and prevention services.

The document provided advice on how to prioritize implementation in different types of health facilities since WHO and UNAIDS had recognized resource and other constraints may prevent immediate implementation of the new method.

It said increase access to HIV testing and counselling was very essential to promoting earlier diagnosis of HIV infection, which could maximise the potential benefits of life extending treatment and care as well as allowing people with HIV to receive information and tools to prevent HIV transmission.

Source: http://www.myjoyonline.com/health/200706/5713.asp

Monday, June 11, 2007

Asia-Pacific Countries Should Increase Access To HIV Testing, Counseling, Health Services, U.N. Agencies Say

By, Medical News Today, June 8, 2007

Governments in Asia and the Pacific should work to increase access to HIV testing, counseling and health services in their countries, the World Health Organization, UNAIDS and UNICEF said in a statement released on Monday, the AP/International Herald Tribune reports. The statement was released at the opening of a three-day gathering of experts, advocates and delegates in Phnom Penh, Cambodia, to discuss strategies aimed at improving HIV/AIDS services in the region. The agencies said that fewer than 10% of the estimated 8.5 million people living with HIV/AIDS in the Asia-Pacific region know their status. "With so few people aware of their status, efforts to prevent new infections and treat those who are positive are becoming more difficult," the statement said (AP/International Herald Tribune, 6/4).

According to UNICEF, poor infrastructure and limited human resources in the region also hinder the capacity of health services to provide necessary HIV testing and counseling. In addition, stigma and discrimination associated with HIV/AIDS prevent many people from actively seeking treatment, the agencies said. In response to the problem, United Nations agencies are calling for increased client- and provider-initiated testing and counseling, as well as a strengthening of prevention, treatment and care services. "As we work to scale up testing and counseling suitable to the regional context, we must safeguard the rights of those who test positive while securing resources for training in the health care system to further reduce stigma and discrimination," UNAIDS Asia-Pacific Regional Director Prasada Rao said, adding, "We need a greater commitment to change attitudes about the virus and strengthen political will to make anti-discrimination policies a reality" (UNICEF release, 6/4).

The agencies also said that more priority needs to be given to HIV-positive children in the region. There are an estimated 64,000 children living with HIV in the region who need treatment access but only one in five receives it, the statement said, adding that nearly all such children live in Cambodia, India and Thailand. "By increasing access to early diagnosis of HIV in infants and children, we are in a better position to improve the quality of life for children who test positive by providing better care, support and treatment," Anupama Rao Singh, director of UNICEF's East Asia and Pacific Regional Office, said (AP/International Herald Tribune, 6/4).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=73391