Voluntary Counseling and Testing

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

Wednesday, June 06, 2007

HIV testing - a rethink needed

By, IRIN PlusNews, May 30, 2007

Nairobi - Less than 12 percent of men and 10 percent of women in sub-Saharan Africa have been tested for HIV and received their test results, despite high levels of knowledge about the existence of HIV and the increasing provision of life-prolonging drugs through the public health sector.

The United Nations World Health Organization (WHO) on Wednesday called for health care providers to now begin routinely recommending an HIV test to patients attending their facilities, in a bid to increase the numbers of people who know their status. Until recently, the primary model for providing HIV testing and counselling has been client-initiated voluntary counselling and testing (VCT), rather than provider-initiated.

"WHO and UNAIDS strongly support the continued scale up of client-initiated HIV testing and counselling, but recognise the need for additional, innovative and varied approaches," WHO and UNAIDS said in new testing guidelines released this week. "Health facilities represent a key point of contact with people with HIV who are in need of HIV prevention, treatment, care and support."

The uptake of regular VCT has been limited by low coverage of services, fear of stigma and discrimination, and the perception by many people that they are not at risk. Approximately 80 percent of people living with HIV in low- and middle-income countries do not know their HIV status, WHO noted.

"Scaling-up access to HIV testing and counselling is both a public health and a human rights imperative," WHO HIV/AIDS director, Dr Kevin De Cock, said at a press conference. "Without a major increase in HIV testing and counselling in health facilities, universal access to HIV prevention, treatment and care will remain just a noble goal."

Shifting approach

Views on HIV testing have begun to shift: public health facilities in countries including Botswana, Kenya and Zambia are now routinely offering HIV tests to their patients.

"In Zambia, when provider-initiated testing was introduced, it was widely accepted for paediatric HIV testing, as well as in maternity, TB [tuberculosis] and VD [venereal disease] clinics," said Paul De Lay, UNAIDS director for monitoring and evaluation.

Integrating HIV testing into conventional health services in Botswana has increased testing uptake from 64 percent in 2004 to 83 percent in 2005, while the number of HIV positive pregnant women accessing antiretroviral (ARVs) drugs to prevent mother-to-child transmission has also risen significantly.

But there has been some debate about the effectiveness of provider-initiated testing in resource-poor settings where ARVs and other HIV services are not available.

"We are not pushing for stand-alone testing," said De Lay. "We are hoping that the phasing up of testing will happen in tandem with a phasing up of treatment as well."

Some community health care workers have also expressed concern that routine HIV testing at health centres has the potential to increase stigma and even deter people from seeking treatment for other conditions, but WHO and UNAIDS said the new guidelines continued to stress the importance of the voluntary and confidential nature of the testing process.

"The guidelines should in no way be read to be a move towards mandatory HIV testing," De Lay said. "They are in support of people's rights to health care."

According to Zackie Achmat, of South African AIDS lobby group, the Treatment Action Campaign, in order to reduce the stigma surrounding the epidemic, the management of HIV/AIDS should be treated as a normal part of medical treatment.

"I tested positive for HIV in 1990, and because I had early testing, I was able to access treatment early," said Achmat. "I have had four sero-negative partners since my diagnosis, and they are all still sero-negative; again, this is because I got tested and was able to take the necessary precautions."

Achmat stressed that the testing needed to be done in an arena of non-discrimination, so that all sections of the population had access to the services.

The guidelines suggest that in generalised epidemics, HIV testing and counselling be recommended to all patients attending all health facilities, while in concentrated, low-level epidemics, countries should consider offering HIV testing and counselling in specific health facilities such as clinics that deal with antenatal care, sexual diseases and tuberculosis.


Source: http://www.plusnews.org/Report.aspx?ReportId=72460

Pregnant Women Urged to Have Test for HIV

By, Samantha Clarke, Coventry Evening Telegraph, June 5, 2007

HEALTH chiefs in Coventry today called for every pregnant woman in the city to book an appointment for an HIV test.

The call comes amid shock revelations that 17 children in the city have been born with the disease because their mothers had not taken advantage of routine tests during pregnancy.

As reported in yesterday's Telegraph Coventry's director of public health revealed babies were contracting the disease from their mothers.

It was revealed many of the babies could have been saved from the disease if the routine tests had taken place.

Coventry Teaching Primary Care Trust spokesman Simon Dudman urged women to take up the tests, stressing their importance in preventing illness.

He said: "Screening for HIV is offered to all pregnant women unless they choose to opt out and it is vitally important that screening for HIV and other conditions is done as early in pregnancy as possible so that appropriate treatment and support can beoffered if needed.

"If a mother-to-be is found to be HIV positive then interventions and treatments can reduce the risk of mother-to-baby transmission and support from specialist services can be offered."

The 17 youngsters have all been diagnosed with HIV since 1990.

Health bosses say a large part of the problem is that their mothers are too scared to take the test.

The 17 are among a total of 568 people in the city living with the disease which can ultimately develop into Aids.

(c) 2007 Coventry Evening Telegraph. Provided by ProQuest Information and Learning. All rights Reserved.


Source: http://www.redorbit.com/news/health/956874/pregnant_women_urged_to_have_test_for_hiv/index.html?source=r_health

Tuesday, June 05, 2007

UN agencies call for scaling-up HIV testing and counseling in Asia and the Pacific

By, People's Daily Online, June 5, 2007

Three United Nations agencies in Phnom Penh on Monday called on governments in Asia and the Pacific to rapidly expand access to HIV testing and counseling services.

Fewer than 10 percent of people infected with HIV in Asia and the Pacific are aware of their status, which is a major obstacle in the campaign to prevent the spread of HIV and to provide AIDS treatment, said a joint press release issued by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

In an effort to overcome these obstacles, the three UN agencies are calling for an increase in client- and provider-initiated testing and counseling, as well as a strengthening of prevention, treatment and care services, the press release said.

Provider-initiated HIV testing and counseling (PITC) is an approach in which health care providers specifically recommend an HIV test, when it fits the local epidemiological and social context, it said, adding that this requires that health facilities have the capacity to ensure that patients receive and understand basic information on HIV and have given informed consent prior to the testing.

Provision of individual post-test counseling and referral to specialized services are steps that follow the HIV test, ideally done at laboratories linked to quality assurance and control schemes, it said.

"Knowing his or her HIV status is a public health and human rights imperative, as it leads to life-extending HIV treatment, care and support services, as well as to evidence-based prevention interventions," said Dr Shigeru Omi, WHO Regional Director for the Western Pacific.

Representatives from the three UN agencies are meeting from June 4 to 6 in Phnom Penh, Cambodia, with experts and civil society delegates to identify strategies for dramatically increasing the availability of HIV testing and counseling services, the press release said.

According to the press release, as of 2006, an estimated 8.5 million people are living with HIV in the Asia Pacific region. In 2006 alone, 1 million additional people were infected and more than 500 000 people died.

More than 20 years after the first reported case of HIV in the region, access to testing and counseling is limited. Although voluntary counseling and testing sites have been established in all countries, poor infrastructure and limited human resources hinder the capacity of health services to introduce and deliver the needed testing and counseling, it said.

Source: http://english.people.com.cn/200706/05/eng20070605_380866.html

UNAIDS, WHO Release New HIV Testing Guidelines

By, Medical News Today, June 4, 2007

The World Health Organization and UNAIDS on Wednesday released new HIV testing guidelines that advise health care workers in countries with an HIV prevalence greater than 1% to routinely offer confidential, voluntary HIV tests to all patients seeking treatment at clinics or hospitals regardless of why they initially sought care, the Washington Post reports (Timberg, Washington Post, 5/31). Earlier WHO and UNAIDS guidelines advised health workers to offer HIV tests only if treatment was available, and health workers often administered the tests only when requested, according to the New York Times (LaFraniere, New York Times, 5/31).

According to the Post, people would be allowed to decline testing under the guidelines. In addition, the guidelines require that everyone who receives an HIV test also receive counseling. The guidelines also advise physicians worldwide to offer testing to patients who show signs of HIV infection (Washington Post, 5/31). The guidelines also suggest HIV testing for anyone whose medical histories suggest possible HIV infection, including children of HIV-positive women and people with tuberculosis (New York Times, 5/31). Botswana, Kenya, Malawi and Uganda already have implemented testing policies similar to the new guidelines (Washington Post, 5/31).

Prevention, Treatment Efforts

Expanded testing might improve prevention efforts, although research has not found a correlation between high rates of testing and decreasing numbers of new HIV cases, according to the Post (Washington Post, 5/31). According to the Times, four out of five HIV-positive people in low- to middle-income countries are unaware of their HIV-positive status, and officials estimate that 20 million people in sub-Saharan Africa are unaware of their status (New York Times, 5/31). In addition, the new recommendations underline the need to identify the millions of HIV-positive people worldwide who need treatment access. Almost five million people in sub-Saharan Africa do not have access to treatment. Identifying more HIV-positive people in need of treatment in countries with limited means might create a larger backlog of people with no access to treatment, according to the AP/Forbes. However, some experts say that increased HIV testing would still be helpful, the AP/Forbes reports. "No one wants a situation where people find out they're HIV positive and can't get anti-retroviral treatment," Jennifer Kates, vice president and director of HIV policy for the Kaiser Family Foundation, said, adding, "But if we waited until everything was perfectly aligned, we would never respond."

In addition, not everyone who tests positive for HIV will need drugs immediately. Previous studies also have also shown that once people are aware of their HIV-positive status, they tend to practice safer sex (Cheng, AP/Forbes, 5/30).

Reaction

Kevin De Cock, head of WHO's HIV/AIDS Department, said that HIV diagnosis is "an essential first step" to curbing the spread of the virus (New York Times, 5/31). He added, "If we are serious about ensuring universal access to drugs, there has to be a fundamental change in the approach to HIV testing" (AP/Forbes, 5/30). Zachie Achmat, an HIV/AIDS advocate in South Africa, said the guidelines are "long, long overdue and require rapid implementation," adding, "It would be entirely substandard medical practice not to recommend that any person in a high-burden country be tested for HIV." According to the Times, some human rights advocates have said that because of stigma associated with HIV/AIDS, no one should be pressured to receive an HIV test if it could lead to job loss or abandonment by families (New York Times, 5/31).

Individual nations will decide whether to implement the new guidelines and allocate funding to expand HIV testing, according to the Post. No new funding from the United Nations has been allocated to the initiative. Derek von Wissell, head of Swaziland's national AIDS council, said that the country likely does not have the resources necessary to implement the new guidelines (Washington Post, 5/31). According to De Cock, the cost of expanding HIV testing is low when compared with the overall cost of HIV prevention and treatment. De Cock added that the new guidelines likely will depend on hiring and training low-level health workers because most low-income countries do not have enough physicians and nurses to handle expanded testing (New York Times, 5/31).


Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=72735&nfid=rssfeeds

Few takers for free HIV testing

By, Dalton Daily Citizen, June 1, 2007

An estimated 180,000 to 280,000 Americans have HIV, the virus that causes AIDS, and are not aware of it, according to the federal Centers for Disease Control and Prevention (CDC).

Health officials across the United States are trying to emphasize HIV testing, especially for those in high-risk groups. But a local event Friday may have demonstrated just how reluctant some people are to get tested.

The North Georgia Health District invited numerous political leaders and prominent Dalton-area residents to the Whitfield County Health Department for “Take Time to Test for HIV.” They were asked to be publicly tested to demonstrate that routine HIV testing is the right thing to do.

“We are trying to encourage local leaders to be an example to the community in taking care of their health,” said Amy Holcombe, HIV prevention coordinator for the North Georgia Health District.

But more than an hour into the two-hour event, just a handful of people had shown up.

HIV testing can be done by drawing blood or, as it was Friday, by using an oral swab.

Before either test is done, patients will undergo counseling with a trained HIV counselor.

“They are trying to help people taking the test identify their risk factors,” Holcombe said.

Some of those risk factors include unprotected sex, sharing needles and multiple sex partners.

“You may not do those things, but if your partner does, that also puts you at risk,” Holcombe said.

The pre-test counseling typically takes 10-20 minutes. The actual test takes just a couple of minutes. It costs $20 at the health department.

“If you don’t have the money, the health department will work something out with you. They won’t let you leave without a test,” Holcombe said.

June 27 will be National HIV Testing Day, and free HIV testing will be offered at the health department and the Dalton Community Center on Frederick Street.

“We would like to be in other places. If someone is interested in having us come and do free testing, give us a call,” Holcombe said.

The CDC recommends that everyone 13 and older be tested for HIV, especially if they have one or more risk factors such as having had unprotected sex.

Holcombe said health officials may get results of a test back within 48 hours, but it could also take several days.

After patients gets those results back, health care officials recommend they go through another period of counseling.


Source: http://www.northwestgeorgia.com/local/local_story_152230551.html

Lack of HIV-infected people in Asia-Pacific know about their status

By, Pravda, June 4, 2007

Fewer than 10 percent of the Asia-Pacific's estimated 8.5 million people who live with HIV know are aware of their status, the UN said Monday, urging the region's governments to boost access to health services.

"With so few people aware of their status, efforts to prevent new infections and treat those who are positive are becoming more difficult," said a joint statement from the World Health Organization, the United Nations Children's Fund - UNICEF - and the U.N.'s coordinating body against the disease - UNAIDS.

Lack of testing and counseling are major obstacles in the prevention of the spread of HIV/AIDS in the region, they said, calling on the region's governments to boost access to health services.

The U.N. agencies released the statement at the opening of a three-day conference of health experts, scientists and community activists about the HIV/AIDS situation in the region. The meeting is being held in the Cambodian capital, Phnom Penh.

WHO regional director Shigeru Omi said in the statement that awareness of a person's HIV status is a public health and human rights imperative. It leads to life-extending treatment, care and support services, and serves as evidence for prevention interventions, he said.

There are an estimated 64,000 children living with HIV in the region who need treatment, but only one in five of them are receiving it, the statement said, adding nearly all them are in three countries - 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," said Anupama Rao Singh, director of UNICEF's East Asia and Pacific Regional Office.


Source: http://english.pravda.ru/news/world/04-06-2007/92734-hiv_asia-0

Make HIV tests compulsory for South Africans

By, The Sunday times, June 3, 2007

The existing voluntary system protects no one, simply deferring individuals’ facing of the truth to when they are already ill and the effectiveness of treatment compromised, writes Francois Venter

The hospital antiretroviral clinic I work in is easy to access, has a very short waiting time and is free, yet the wards in the hospital are filled with people dying of Aids who discovered their HIV status only at admission

South Africa needs a new HIV testing policy. The current model — voluntary counselling and testing, which relies on initiation by the client — is well intentioned but deeply flawed.

It is failing and has failed throughout the world.

In an era where the government has committed itself to treating people with HIV/Aids through its ambitious new National Strategic Plan, we should not accept an HIV-testing policy that permits the majority of South Africans to continue their lives without recognising their risk of HIV infection.

HIV now accounts for half of all deaths in the country. Yet South Africans remain in hopeless denial of their individual risk. Aids denial by senior leaders has obscured the fact that they are joined by almost the entire population: only 2% of South Africans test for HIV each year.

Self-perception of risk is very poor. More than two- thirds of those who tested positive for HIV in a recent large survey by the Human Sciences Research Council (HSRC) reported before the test that they had no risk factors for the virus.

HIV is not a death sentence any more, nor does it attach only to small, already marginalised groups of society; it is an everyday disease of people who have sex. But somehow that message has failed to get through.

The voluntary counselling and testing model emphasises choice and free will. It allows people to delay the choice to test, often until that choice is pre- empted by severe illness, pregnancy or insurance sales people. This has proved fatal for the majority of people with Aids, and consumed massive state resources.

As a clinician, I see huge numbers of people tested when they are severely ill, and when the use of antiretroviral drugs is far more complex and less effective.

The hospital antiretroviral clinic I work in is easy to access, has a very short waiting time and is free, yet the wards in the hospital are filled with people dying of Aids who discovered their HIV status only at admission.

HIV is treatable — current drugs can provide more than 30 years of life or more if started in time. Testing early also allows for the development of support structures, understanding of the complexity of integrating treatment into everyday life, planning for the future and initiation of treatment before the person actually gets sick.

The emphasis on voluntary counselling and testing has allowed individual autonomy to trump public health, regardless of the consequences to broader society.

In the US, it is estimated that those who do not know their status (about 25% of the infected population) account for more than half of all transmissions of HIV. Ignorance fuelled by a denial of risk allows people to put their sexual partner(s) at risk. By contrast, those who know they are HIV-positive take more proactive steps to protect others.

A new universal policy in South Africa could insist on regular testing for healthy adults, either through incentive-linked systems (every well-resourced South African gets tax rebates if having tested that year, or a ‘bonus’ addition to a grant if depende nt on social security) or as an obligation (evidence of a recent HIV test would be required for engagement with any bureaucratic structures in South Africa).

Another possible solution is an “I know my HIV status” certificate issued by approved counsellors at regular intervals. The certificate would not record the HIV test result, simply that the person knows and understands that result, with a date.

The regularly updated certificate may be required for the issuing of all official documents (identity books, drivers’ licences, bank cards, tax submissions, social grant applications) and processes (membership of medical aids, applications for new jobs and university entrance, marriage, continuing to receive a social grant or pension).

The process would normalise testing across all economic levels and, while resource-intensive, would place the onus on the individual and away from healthcare personnel.

This approach respects confidentiality, would enable early diagnosis and intervention, and would allow infected people to plan their futures and their healthcare.

Supporters of the existing system of voluntary counselling and testing argue that the low take-up of HIV-testing is due to the fact that available testing services are dreadful, and that dramatically improving these services would automatically attract large numbers of testers.

The argument does not take into account the HSRC research that shows that most people have a poor perception of their own risk. Why would someone make their way to a testing centre if they did not think there was the possibility of their having HIV?

Opening a host of counselling and testing centres all over the country will not in itself increase testing, given that research shows that access to testing facilities does not seem to be a problem. The HSRC survey found that more than three-quarters of respondents knew of a testing site “nearby”.

Finally, more than 90% of those who had accessed voluntary testing graded their experiences as good to excellent; suggesting that client satisfaction with existing services is high.

Defenders of voluntary counselling and testing suggest that better education about HIV testing would increase the number of testers. But claims that HIV transmission is a disease of ignorance ignores the population’s everyday experience of other repercussions of sex, such as pregnancy and sexually transmitted diseases, as well as the fact that HIV is a common experience in South African life and in the media.

My patients seem to be well informed about Aids and testing, from sources as diverse as church to the TV drama Isidingo. Surveys, too, indicate high levels of knowledge and few pervasive myths about HIV in South Africa.

The most common reason given in the HSRC survey for not testing was the respondents’ belief that they could not possibly be infected. More education is unlikely to solve this.

A number of proponents of HIV-testing models other than voluntary testing have recommended that all people who enter the health system be informed that an HIV test will be conducted on them unless they expressly refuse it — so-called routine opt-out testing. Regrettably, this system will not reach healthy people but will instead focus on those who are already ill or pregnant.

Libertarians and human rights advocates emphasise that the state should not interfere with individuals’ decisions about their health, and that making testing universal would violate autonomy and choice — the “right not to know”.

Yet there are many instances where the state imposes benign legislation to assist with individual and public health. It legislates around a range of issues for the individual’s own good: seat belts are compulsory, smoking is restricted and there are moves afoot to force all South Africans to save for retirement and to contribute to medical aid schemes.

Legislating that you need to know your HIV status for your own good has a precedent.

Finally, everyone with HIV gets to know this eventually. By ensuring the right not to know we simply defer this discovery — and diagnosis — to the Aids stage, when someone is at their most vulnerable.

It should be acknowledged that HIV testing is a first step, not an end in itself. People with the virus still need to be able to enter the country’s system of care, a system that does not always function well.

The model of universal testing will compel the state to expand radically the HIV-testing facilities, possibly far beyond the narrow access in healthcare facilities, as well as dramatically scale up and improve HIV care services and human resources to accommodate the increased demand due to increased awareness.

It will be a very necessary allocation that will save our country the huge consequences and financial burden of a preventable and treatable disease.

We have had 20 years of a failed voluntary programme. We should transform it by urgently finding a way to make regular HIV-testing universal.


Dr Venter is clinical director at the Reproductive Health and HIV Research Unit and honorary lecturer at the Steve Biko Centre for Bioethics, both at the University of the Witwatersrand, and president of the Southern African HIV Clinicians Society. He writes in his personal capacity


Source: http://www.suntimes.co.za/PrintEdition/Article.aspx?id=481394

Monday, June 04, 2007

WHO prescribes HIV testing for all

By, The Times of India, June 3, 2007

The World Health Organisation (WHO) has rolled out a new recipe to fight the HIV\AIDS epidemic: doctors should urge all their patients to undergo the HIV test rather than recommending it only to a few. Of course, people who don't want to undergo the test can choose to opt out.

On Wednesday, the WHO unveiled its latest recommendation- a far cry from its older module of seeking voluntary testing for HIV\AIDS-ostensibly to identify the 'silent epidemic'. Persons who don't know they are infected (and WHO believes there are millions who don't) will thus know their status, take steps to not infect others and seek timely help, goes the new WHO logic.

In New Delhi, NACO (National AIDS Control Organisation) secretary K Sujatha Rao welcomed the new guidelines. "We are positive about it. What is wrong with doctors advising patients to test for HIV?" she asked. "We can't stretch the confidentiality clause to the point that it affects the patient's health." Indian patients reach hospitals too late for any help to be provided. "Such a recommendation would only help us treat patients," she added.

While NACO now brainstorms on how to roll out the new recommendations and tackle the ethical issues, many public health experts in India are not sure about the mandate. "We have to use such guidelines intelligently," says Dr R D Lele, who is credited with identifying and treating the first HIV-positive patient of India over 20 years ago. "We only have to target sexually-active persons in the age group of 16 to 45 years, drug users and patients who have undergone blood transfusions," he says. "What is the point of asking a 65-year-old patient with cough and cold to undergo the test?"

Moreover, as Dr Lele points out, if the test is offered routinely to all patients, there is a danger of false positives. "The HIV test is known to give false positive in case of patients suffering from malaria or chronic liver disease."

In India, there also is the problem of stigma attached to the HIV diagnosis. In Africa, the attitude is different considering that the epidemic has wiped out tens of thousands in their productive age group. In the US, the government is trying to implement the Centers for Diseases Control recommendation for annual testing for people in the age group of 16-35 years.

But in Kolkata, the staff of the Calcutta Medical College Hospital refused to touch the body of a young AIDS patient who died there two days ago. The extent of stigma attached to the HIV\AIDS tag is still immense. "A couple of months back, a pregnant woman died outside a government hospital in Indore. In Lucknow, a renal failure patient who was HIV-positive had to wait for 16 hours before activists could get him a hospital bed," pointed out HIV rights activist-writer Bobby Ramakant from Lucknow.

Experts recommend that India should first put in place the many checks advised in the WHO guidelines: counselling before and after the HIV tests, introduce universal precautions such as double gloves for doctors and medical staff treating HIV\AIDS patients, etc. "We first have to work towards reducing the stigma towards HIV\AIDS in healthcare settings," says Ramakant.

Akila Shivdas from the Centre for Advocacy & Research (CFAR), which has been working in the field of HIV\AIDS advocacy, felt WHO's new recommendations are a sureshot prescription at normalising the epidemic. "The WHO idea is that by not according HIV\AIDS a special category, the epidemic can be normalised. But this normalisation process can't begin from the top, it has to start from within the community," she advised.

She points out to Thursday's news about the emergence of new HIV\AIDS hotspots in Uttar Pradesh and Bihar. "We now have small towns and villages with 1% incidence of HIV in pregnant women. This is considered high. If the testing is made mandatory in such areas without the proper buildup, it can have a disastrous effect."

The WHO team agrees that the shift from voluntary testing to provider-driven testing is drastic. "This is radical in the sense that things have to change," said WHO HIV/AIDS director Kevin De Cock. "Across the world, people with HIV are flowing through healthcare settings, not being diagnosed and not being offered the advantages of knowing their status."

But it remains to be seen if the formula will work in India, in the manner it is meant to.


Source: http://timesofindia.indiatimes.com/Cities/WHO_prescribes_HIV_testing_for_all/rssarticleshow/2093269.cms