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
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
posted by AIDS-Care-Watch at 11:45 am
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