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

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

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