ACW: Voluntary Counselling and Testing

Afro-Arab youth shun HIV testing

2008-03-17T09:51:00.000+07:00

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

HIV test targets 'will be missed'

2007-08-14T11:18:00.000+07:00

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

More older people seeking anonymous HIV testing: report

2007-07-27T13:32:00.000+07:00

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

2007-07-23T10:10:00.000+07:00

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

2007-07-23T10:05:00.000+07:00

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?

2007-07-20T14:17:00.000+07:00

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

2007-07-20T11:52:00.000+07:00

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

2007-07-20T11:49:00.000+07:00

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

New HIV testing guidance out

2007-06-15T13:09:00.000+07:00

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

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

2007-06-11T12:17:00.000+07:00

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

HIV testing - a rethink needed

2007-06-06T11:48:00.000+07:00

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

2007-06-06T10:32:00.000+07:00

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

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

2007-06-05T11:34:00.000+07:00

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

2007-06-05T11:31:00.000+07:00

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

2007-06-05T11:28:00.000+07:00

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

2007-06-05T11:24:00.000+07:00

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

2007-06-05T11:19:00.000+07:00

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

WHO prescribes HIV testing for all

2007-06-04T11:45:00.000+07:00

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

WHO calls for massive expansion in HIV testing

2007-05-31T09:27:00.000+07:00

By, Ben Hirschler, Reuters Foundation, May 30, 2007

LONDON, May 30 (Reuters) - Voluntary HIV tests should be offered to all patients attending clinics, for whatever reason, in countries where AIDS is widespread, the World Health Organisation said on Wednesday.

Elsewhere, testing is recommended for all patients attending selected facilities, such as antenatal or sexual health clinics.

Issuing new guidance to governments, the global body said a major expansion in testing was essential if the world was to beat the HIV/AIDS pandemic, which has killed more than 25 million people in the past quarter of a century.

The AIDS virus today infects around 40 million worldwide, most of them in sub-Saharan Africa, where just 12 percent of men and 10 percent of women know their HIV status.

"This is radical in the sense that things have to change," WHO HIV/AIDS director Kevin De Cock told Reuters.

"Across the world, people with HIV are flowing through healthcare settings, not being diagnosed and not being offered the advantages of knowing their status."

Drugs can hold HIV at bay and keep patients alive, but unless people know they are infected they will not seek treatment. They are also more likely to infect others.

The WHO says less than 20 percent of HIV-positive people in low and middle-income countries know they are infected.

The situation is better in rich countries, yet even in United States an estimated 25 percent of infected people are unaware they are carrying the virus, while in Europe the rate is around one third.

Until now, most testing has been "client-initiated", with individuals having to actively seek an HIV test. But in future, the WHO wants to see "provider-initiated" schemes, with testing becoming the norm at health centres, unless a patient declines.

Universal coverage is recommended for countries gripped by a generalised epidemic, where the HIV prevalence rate in pregnant women is consistently above 1 percent -- which includes most of Africa and parts of the Caribbean -- while targeted testing is suitable for concentrated or low-level epidemics.

Some countries in Africa, such as Botswana and Kenya, have already started broad testing programmes and De Cock said the price of around $1 for a simple, rapid test meant that cost should not be an insurmountable obstacle.

Source: http://www.alertnet.org/thenews/newsdesk/L25213198.htm

Campaign urges people to take Aids test

2007-04-20T11:04:00.000+07:00

By, Swissinfo, April 19, 2007

A new Swiss anti:Aids campaign is urging people to take an HIV test if they have any doubts about their past sexual encounters.

Organised by the Swiss Aids Foundation and Federal Health Office, it calls on people to take the necessary precautions before embarking on a new relationship to minimise the risk of infection.

"Remember that when you meet a new partner, you will be having sex with his or her past. This is the message that we want to convey with the posters in our Love Life ? Stop Aids campaign," said Roger Staub, head of the Health Office's Aids unit.

One of the three posters used in this year's campaign, launched earlier this week, shows a family ? small girl, mother and father.

But five women, who look like prostitutes, can be seen in the background of the picture.

The other posters show a heterosexual couple in a bath and a homosexual couple in the bedroom ? both surrounded by previous lovers.

"When the past becomes a risk to the relationship people should ask themselves whether it is necessary to take the test," Staub said.

Questionnaire
People can find out if they should take the test, based on their sexual habits, by completing a simple scientifically prepared questionnaire on the Check:your:lovelife.ch website.

"We have created a simple but very precise tool that gives advice on taking the test," Staub said.

He said HIV detection had more prominence than in past campaigns.

"This year's campaign has raised the question of previous sexual encounters and therefore we couldn't avoid bringing up the test, which is the only sure way somebody can quash any doubts of a possible infection," Staub said.

He said that the aim was not to increase the number of tests being taken but to make groups at risk more aware.

"In the past we were careful about putting the test in the spotlight. Our priority is still to promote sexual attitudes that avoid the risk of infection," said Staub.

"If we speak about tests, then it means that a risky sexual experience has already taken place, and that is not what we want."

HIV and gay men
In recent years there has been a worrying increase in the number of HIV cases among gay men in ? up 34 per cent in 2005 : which has led to some questioning of Health Office campaigns by gay organisations.

Staub stressed that specific prevention for different groups was not part of the Love Life ? Stop Aids campaign.

"We have two major objectives: the first is to avoid a massive increase of the HIV virus among the general population. The second is to stop the increase in risk groups.

"We want to reach the first objective with this campaign without challenging the second," he said.

The Health Office was getting its message across to gay men through different, channels, he said.

Campaign successes
The first Health Office anti:Aids campaign goes back to 1987 and Staub says there have been successes.

"After 20 years of campaigns, we can say that there has been no massive spread of Aids among the Swiss population. And this was one of our objectives," Staub said.

"In the 1980s our departure point was not much different from that of Africa. The explosion of the virus in this continent shows what could happen without prevention," he said.

Staub says that Swiss campaigns are also envied abroad. "People abroad admire us for the non:moralistic and clear language we use, and for choosing courageous images," he said.

But he admits that it is difficult at times to find the right balance.

"The secret of a campaign funded by taxpayers' money is to irritate people enough for them to take notice, but without exaggerating, and to avoid our funding being cut. We have always operated on the limits of tolerance."

swissinfo, based on an Italian article by Andrea Tognina

Source: http://www.nzz.ch/2007/04/19/eng/article7731640.html

Half Of HIV Spread By Newly Infected

2007-03-12T15:35:00.000+07:00

By, Science Daily, March 7, 2007

A new study led by McGill University researchers shows that half of all HIV transmissions happen when newly infected people don’t know they are carrying the virus and may not even test positive for it.

The study, published in the April edition of the Journal of Infectious Diseases and already available online, followed 2,500 patients in eight Montreal HIV clinics over eight years. It showed that newly infected patients are eight times more likely to transmit the virus than those in the chronic stage of AIDS given the same behaviour.

Dr. Mark Wainberg, Director of the McGill AIDS Centre and internationally respected AIDS researcher, presented the findings at an academic AIDS conference in Los Angeles March 1 with lead author Dr. Bluma Brenner of the McGill Faculty of Medicine and the Jewish General Hospital.

“The most alarming thing is the confluence of a highly infectious state and the lack of awareness of that state,” said Dr. Wainberg. “It means we have to reconsider a lot of what we’re doing, both on the public education front and on the early intervention front.”

McGill Professor of Medicine and McGill University Health Centre (MUHC) AIDS researcher Dr. Jean-Pierre Routy, who was also instrumental in the study, said the Montreal urban population provided the ideal sample for the groundbreaking survey. “We had the infrastructure and the data here to get a comprehensive picture.” The study also involved researchers at Université de Montréal and at private and public AIDS clinics in the city.

The findings could change not only how soon people get tested after engaging in high-risk behaviour, but how they view that behaviour. “It has been shown that an HIV-positive diagnosis modifies high-risk behaviour,” said Dr. Wainberg. “So the more actively we can seek out and find newly infected people for testing and counselling, the better.”

Source: http://www.sciencedaily.com/releases/2007/03/070305084232.htm

Botswana: We Need Privacy in HIV Tests - the Disabled

2006-12-21T09:14:00.000+07:00

By, Thato Chwaane, Mmegi/The Reporter (Gaborone), December 20, 2006

The president of Botswana Association of the Deaf, Maggie Mapharing and an intern at BONELA, Shirley Keoagile, have cried foul at being left behind in the intervention strategies in the fight against HIV.

"It is difficult for us to go for HIV tests due to lack of confidentiality. This is because we have to go with sign language interpreters, which compromises our right to confidentiality," Keoagile said. She said confidentiality is important in HIV testing, and lack of it or the absence of a guarantee it becomes a hindrance.

Both Mapharing and Keoagile have a hearing impairment and are advocates for people with disability.

Keoagile said there are many who are HIV positive but cannot come out in the open for fear of further discrimination and stigma.

"Very few of us are aware about HIV and have less confusing information. However, illiteracy is the barrier we are facing because most of us do not know how to read sign languages or can lip-read," she said.

Keoagile said at the recent workshop on HIV/AIDS and the deaf, where they were taught on different issues such as ARV, PMTCT, CD4 count among others, it was evident that people were still behind in their awareness. She said although three quarters of the participants tested for HIV, she wondered who would assist them once they got home. She said that communication with people with hearing impairment was a big challenge even to family members.

She said interpretation conducted at the workshop was made in American Sign Language used in textbooks in schools, however it is different from Botswana sign language. She said the message should be clear and that they are people in need of special attention. "Is it not a violation of human rights, if one is tested when they are not ready?" she asked.

Keoagile works on a project of HIV/AIDS, human rights and people with disabilities at BONELA.

Mapharing noted that she had a sick client whom she took to the hospital. "I had to be by her side when waiting for the results, and when they came out, she broke down," she said.

She said that she had to continue to assist her, even going with her for regular check-ups until she was able to accept her situation. "Imagine it was only one client, and it was so burdensome. But where is the privacy and confidentiality?" she asked.

They noted that there was no single board member with a disability championing the cause for the disabled at Botswana Society for Disabled.

Mapharing said one "needs to understand why they should go for an HIV test or how HIV infection is transmitted". She said through Botswana sign language, more people could hear and understand why they needed to test. Mapharing said there is a need of strong campaign and community outreach, education on pregnancy, sexual reproductive health including targeting of parents. She said there was need for people to learn the deaf culture in order to communicate. "Otherwise they (the deaf) will be lost and remain in the dark," she said.

The two called for sufficient interpreters who are able to interpret in Botswana sign language, not volunteers who abandon their duties. "Botswana needs to promote its own sign language through research and consultation," she said.

Mapharing said by next year, she is hopeful of Sign Language Council or even an introduction of the course at the University of Botswana and eventually a dictionary.

Source: http://allafrica.com/stories/200612200892.html

WHO: Provider-initiated HIV testing and counselling in health facilities

2006-12-19T10:45:00.000+07:00

WHO/UNAIDS Guidance on Provider-initiated HIV Testing and Counselling in Health Facilities, November 27, 2006

EXECUTIVE SUMMARY

1. BACKGROUND

Limited knowledge of HIV status in many countries means that large numbers of people fail to receive HIV treatment, care and support in a timely manner, and do not take steps to prevent transmission to others because they do not know they are infected. Efforts are needed to expand voluntary counselling and testing (VCT) services and to provide HIV testing in a more diverse range of settings than is currently the case. Because health facilities represent a key point of contact with people who are potentially infected with HIV, provider-initiated testing and counselling in health facilities should be seen as one of several potential components in an overall strategy to increase uptake of HIV testing and counselling and knowledge of HIV status.

This document responds to growing demand at country level for basic operational guidance on provider-initiated testing and counselling in health facilities. It is based on an assessment of available evidence and is intended for a wide audience including policy-makers, HIV/AIDS programme planners and coordinators, health-care providers, non-governmental organizations providing HIV/AIDS services and civil society groups.

The document recommends an "opt-out" approach to provider-initiated HIV testing and counselling in heath facilities, including simplified pre-test information, consistent with WHO policy options developed in 2003 and with the 2004 joint UNAIDS/WHO policy statement on HIV testing and counselling. With this approach, an HIV test is recommended as a standard part of medical care for all patients attending health facilities in generalized HIV epidemics, and in certain settings in concentrated and low-level epidemics. Individuals must specifically decline the HIV test if they do not want it to be performed.

The process of adapting this guidance at country level will require an assessment of the local epidemiology as well as the risks and benefits of provider-initiated testing and counselling, including an appraisal of available resources, prevailing standards of HIV prevention, treatment, care and support, and the adequacy of social and legal protections available to those living with, or at risk of exposure to, HIV. Implementation of provider-initiated testing and counselling should be undertaken in consultation with key stakeholders. Phased implementation in priority settings and careful monitoring will enable the best use to be made of available resources and help to avoid negative outcomes, including stigma and discrimination, violence and unmet demand for treatment and other services.

Provider-initiated testing and counselling in health facilities should always aim to do what is in the best interests of the patient. This requires giving individuals sufficient information to make an informed and voluntary decision to be tested, including an opportunity to decline the test. Post-test counselling and referrals to
appropriate services are essential for all patients regardless of the test result, and patient confidentiality must always be maintained.

2. RECOMMENDATIONS

Guidance in the document is categorized according to HIV epidemic type and refers to two types of provider-initiated testing and counselling: diagnostic HIV testing and HIV screening. Provider-initiated testing and counselling is voluntary and the “Three C’s” – informed consent, counselling and confidentiality – must be observed for both these forms of provider-initiated testing and counselling.
• Diagnostic HIV testing in all epidemic types

Diagnostic HIV testing should be part of the normal standard of care anywhere, recommended for adults, adolescents or children who present to clinical settings with signs and symptoms or medical conditions that could indicate HIV infection, including tuberculosis (TB).

Diagnostic HIV testing for children born to women who have participated in programmes for the prevention of mother-to-child transmission (PMTCT) and who were found to be HIV-positive is considered a routine component of the follow-up care for these children. Diagnostic HIV testing is also recommended for children with suboptimal growth and malnutrition in generalized epidemics, and may be considered for children under certain circumstances in other settings.

Surgical patients may require diagnostic HIV testing for diagnosis and management of conditions potentially associated with HIV. However, HIV testing of surgical patients is not justified simply for knowledge of HIV status by service providers, and HIV test results must not be used to deny surgery or clinical services that are otherwise indicated.

• HIV screening in generalized epidemics

WHO and UNAIDS recommend HIV screening for all adults and adolescents seen in all health facilities in generalized epidemics, regardless of the individual’s reason for presenting to the facility. This recommendation applies to medical and surgical services, public and private facilities, and inpatient and outpatient settings.

Resource and capacity constraints will likely require prioritization of sites for implementation of HIV screening, guided by an assessment of the local epidemiological and social context. The following health facilities may be considered for the implementation of HIV screening (in order of priority):
o Antenatal, childbirth and postpartum health services
o Sexually-transmitted infection (STI) services
o Health services for most-at-risk populations
o Other medical inpatient and outpatient facilities

o Services for children under 10 years of age
o Surgical services
o Reproductive health services, including family planning
o Services for adolescents.

• Options for provider-initiated testing and counselling in concentrated and low-level HIV epidemics

HIV screening is not recommended for all persons attending all health facilities in settings with concentrated and low-level epidemics, since most people will have low risk for exposure to HIV.

In settings with low-level and concentrated epidemics, the first priority should be to ensure that diagnostic HIV testing is appropriately and correctly performed for adults, adolescents and children who present to health facilities with signs and symptoms suggestive of underlying HIV infection, including underlying tuberculosis. When data have shown that HIV prevalence in patients with tuberculosis is very low, diagnostic HIV testing of all such patients may not remain a priority.

Decisions about whether to implement HIV screening in certain settings in low-level and concentrated epidemics should be guided by an assessment of the epidemiological and social context. Consideration may be given to the implementation of HIV screening in the following health facilities or services:

• STI services
• Health services for most-at-risk populations
• Antenatal, childbirth and postpartum services.

3. ENABLING ENVIRONMENT

Although access to antiretroviral therapy should not be an absolute prerequisite for the implementation of provider-initiated testing and counselling, provider-initiated testing and counselling should be accompanied by a minimum set of HIV-related prevention, treatment, care and support services and implemented within the framework of a national plan to achieve universal access to antiretroviral therapy for all who need it.

At the same time as provider-initiated testing is implemented, efforts must be made to put in place a supportive policy and legal framework to maximize positive outcomes and minimize potential risks to the patient. This includes an ethical process for obtaining informed consent, measures to maintain confidentiality and protect privacy and measures to prevent stigma and discrimination in health care settings. National plans to achieve universal access to HIV prevention, treatment, care and support for all who need it should also address beneficial disclosure and ethical partner notification as well as broad social measures to protect the human rights of people living with HIV/AIDS and at risk of exposure to HIV.

4. PRE-TEST INFORMATION AND INFORMED CONSENT

With the "opt-out" approach to provider-initiated testing and counselling recommended by WHO and UNAIDS, an HIV test is recommended as a standard part of the patient's medical care. Individuals must decline the test if they do not want it to be performed.

For both diagnostic HIV testing and HIV screening, the health care provider should at a minimum provide the patient with the following information:

• The reasons why HIV testing and counselling is being recommended
• The clinical and prevention benefits of testing, as well as the potential adverse outcomes
• The fact that the patient has the right to decline the test and that testing will be performed unless the patient exercises that right
• The fact that declining the test will not affect the patient's access to services that do not depend upon knowledge of HIV status
• The follow-up services that are available in the case of either an HIV-negative or an HIV-positive test result
• In the event of an HIV-positive test result, encouragement of disclosure to other persons unknowingly at risk of exposure to HIV
• An opportunity to ask the health care provider questions.

Additional pre-test information for women who are or may become pregnant should include:

• The risks of HIV transmission to infants
• Measures that can be taken to reduce mother-to-child transmission, including antiretroviral prophylaxis and infant feeding counselling
• The benefits to infants of early diagnosis of HIV.

Pre-test information should be tailored to the client's age and developmental stage; special considerations will apply for obtaining informed consent from children and adolescents. Verbal communication is adequate for the purpose of obtaining informed consent to either diagnostic HIV testing or HIV screening.

Declining an HIV test should not result in any denial of services, coercive treatment or breach of confidentiality, nor should it affect a person’s access to health services that do not depend on knowledge of HIV status.

5. POST-TEST COUNSELLING

Post-test counselling is an integral component of the HIV testing process and all individuals undergoing HIV testing must be counseled when their test results are given, regardless of the test result.

Counselling for those who test HIV-negative should include the following minimum information:
• An explanation of the test result
• Advice on methods to prevent the acquisition of HIV and provision of condoms.

The health worker and the patient should jointly assess whether the patient needs referral to more extensive post-test counselling or additional prevention support.

In the case of individuals who test HIV-positive, the health care provider should:

• Explain the result simply and clearly, and give the patient time to consider it
• Ensure that the patient understands the result
• Allow the patient to ask questions
• Help the patient cope with emotions arising from the test result
• Discuss any immediate concerns and assist the patient in determining who in her/his social network may be available and acceptable to offer immediate support
• Describe follow-up support available in the health facility and in the community
• Arrange a specific date and time for follow-up visits or referrals for treatment, care, counselling, support and other services as appropriate (e.g. tuberculosis treatment, OI prophylaxis, STI clinics, family planning clinics, antenatal clinics, opioid substitution therapy, and needle and syringe exchange programmes

• Provide information on how to prevent transmission of HIV, including provision of condoms
• Provide information on other relevant preventive health measures such as good nutrition and preventing endemic diseases, such as the use of anti-malarial prophylaxis and insecticide-treated bed nets
• Discuss possible disclosure of the result, when and how this may happen and to whom
• Encourage and offer support for testing and counselling of partners and children
• Discuss possible steps to ensure the physical safety of women who test positive.

In addition, post-testing counselling for women identified as HIV-positive should emphasize the following:

• Use of antiretroviral drugs to prevent MTCT, and for her own health, when indicated and available
• Childbirth plans
• Adequate maternal nutrition, including iron and folic acid
• Infant feeding options and support to carry out the mother’s infant feeding choice
• HIV testing for the infant and the follow-up that will be necessary.

6. FREQUENCY OF TESTING

How often individuals are tested will depend on the continued risks taken by the individual, the availability of human and financial resources and HIV incidence in the setting. Re-testing at least once a year may be beneficial for individuals at high risk of exposure to HIV, such as persons with a history of a sexually transmitted infection, sex workers and their clients, men who have sex with men, injecting drug users, and sex partners of people with HIV. HIV-negative women should be tested with each new pregnancy, particularly those in high-prevalence settings or high-risk populations. Re-testing late in pregnancy may also be advisable. Individuals who are known to be HIV-positive do not require re-testing.

7. HIV TESTING TECHNOLOGIES

An important recent advance has been the introduction of highly sensitive and specific, simple-to-use, rapid antibody tests. Use of rapid HIV testing for provider-initiated testing and counselling has many advantages, particularly for health facilities where access to laboratory services is poor.

Decisions on whether to use rapid tests or ELISA tests for provider-initiated testing and counselling should take into account factors such as cost and availability of the test kits, reagents and equipment; available staff, resources and infrastructure; the number of samples to be tested; sample collection and transport; the setting in which testing is proposed; convenience, and the ability of individuals to return for results.

Virological testing, while more complex, expensive and requiring highly trained staff, is optimal for diagnosing HIV infection in children of less than 18 months.

8. MONITORING AND EVALUATION

The implementation and scale up of provider-initiated testing and counselling needs to be monitored and evaluated for coverage, quality, adverse outcomes, funding and overall performance of services. Routine programme monitoring may need to be supplemented with focused evaluations on specific aspects of implementation, such as health care worker performance and patient satisfaction.

To read the report, please go to: http://www.who.int/hiv/topics/vct/publicreview/en/index.html

To participate in the debate on provider-initiated HIV testing and counselling in health facilities, please submit your comment below the blog or write to tina@aidscarewatch.org

KENYA: Muslim women in the north defy custom to fight AIDS

2006-12-08T16:07:00.000+07:00

By, IRIN PlusNews, November 9, 2006

LODWAR - A group of Muslim women in the dusty town of Lodwar, northern Kenya, are breaking with tradition to speak openly about HIV/AIDS and other sexually transmitted diseases.

As in many Muslim societies, the people of Lodwar, in the district of Turkana, have a deep-seated aversion to discussing sexual matters, but the reality of the epidemic has forced them to educate themselves about it.

Many of the female members of Lodwar's mosque attend a weekly meeting where they give each other support and advice. Each of the 51 members is asked to donate 50 shillings (US$0.70) every week, which is then given to a member in need or on a rotational basis. The small sums raised come in very handy for some of the elderly women in the group who are looking after children orphaned by AIDS and women who are already infected and need additional care.

Merlin, a UK-based medical NGO, has visited the women's group to provide voluntary counselling and testing services and HIV/AIDS education.

"At first it was very difficult, as many Muslims refuse testing; many believe that you are working as a commercial sex worker [if you go for testing]," said Amina Bashair, the group's chairwoman. "Once we had received some education, we realised that it was not true and would not bring shame on our religion, so some of our group volunteered for testing."

The meetings encourage the women to be more open with their questions about HIV/AIDS. "It was the first time I had heard of such a thing; it was very informative," said Alima Nakwa, an elderly member of the group after the Merlin visit.

"Before, people from the mosque were dying but we didn't know how," said Rukia Imoni, another member. "Now we know that it was AIDS and [will] not be scared."

The use of condoms is rare in Turkana, and some of the women said they would have no idea where to get them. During Merlin's educational session they were shown how to use a condom, a first for most of them. "It was something so strange to me; what it is and what it can do," said Imoni.

The risks to the women in Turkana, where the HIV prevalence is 11.4 percent - twice the national average - are many: "The men are polygamous and this increases the risk; some men are also unfaithful," said Bashair. The continued use of traditional birth attendants was also "a problem ... as they [birth attendants] do not have access to gloves while birthing", raising the risk of contracting HIV during childbirth if either the woman or the birth attendant is HIV positive.

Men have not been targeted; although they are keen to learn, they feel they need a male educator to teach them. "If a woman was to teach HIV then there should be a curtain [separating her from the men in the Mosque]," said Yahya Asuman, administrator of the Lodwar Islamic Centre, adding that most men wanted to be educated according to Islamic rules. "Only when we get letters from the Ministry of Health do we announce such things."

The Mosque's Imam [senior Muslim scholar] rarely talks about HIV/AIDS or related issues.

Teaching such a conservative society about HIV/AIDS is proving no easy task for the women's group. Turkana has one of Kenya's lowest literacy rates, and the women complained that besides being unable to read the existing literature on the disease, the messages themselves were not aimed at Muslims, who needed to be educated in line with their religious beliefs.

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Source: http://www.plusnews.org/AIDSReport.ASP?ReportID=6531&SelectRegion=East_Africa&SelectCountry=KENYA

HIV Test, Not a Condition for Employment --Workpolicy

2006-12-08T13:45:00.000+07:00

By, Funmi Komolafe, Vanguard (Lagos), December 7, 2006

Nigeria - World Aids Day was marked , Dec. 1st, in the spirit of the day, Labour Vanguard continues its enlightment on the "National Workplace Policy On HIV/AIDS".

This second part of our report, highlights the responsibilities of the employer and the employee in the work place.

Special attention was given to "Protection from Stigma, Discrimination and Exclusion" in Section 8.2.

To protect PLWA, the policy states, "there shall be no obligation placed on employee to reveal his or her HIV/AIDS status to the employer". In order to ensure that they are not discriminated against on account of medical expenses, the policy recommends that "employees living with HIV/AIDS shall not be denied access to statutory benefits and occupationally related welfare schemes". Such persons shall have access to health insurance coverage and " no HIV test shall be imposed as a condition to access any health insurance scheme" and this includes their participation in the National Health Insurance Scheme.

For assurance companies, the policy states "No assurance company shall deny workers access to any insurance coverage on the basis of his or her status".

In order to ensure continuation of employment relationship, the policy states, "HIV infection or AIDS shall not provide a basis for termination of employment. Where fitness to work is compromised by HIV/AIDS and related illness, the employer shall make efforts and arrangements aimed at providing reasonable accomodation for the individual affected".

In order to have access to medicare and counselling, it is recommended that employers should provide flexible hours of work so that PLWA can access counselling, treatment and care during working hours. However, this is expected to be handled on a case by case basis by individual establishments.

Protection of the rights of job seekers.

With the new policy, no employer in Nigeria is expected to subject prospective employees to HIV screening. It is clearly stated that "the only medical criterion for entry to employment is fitness to work and nothing in the pre-employment examination shall oblige or require any candidate to declare his or her HIV status.

For job placements outside the shores of Nigeria, which requires HIV test for placement and residence, the policy states, "the requirement must appear in the vacancy announcement or advertisement for appropriate action by the Federal Ministry of Labour and Productivity and the ministry of foreign affairs.

Consideration was given to PLWA when due for retirement as it is recommended that "a proper retirement strategy will be worked with adequate support being provided for workers living with HIV and AIDS in and out of work in a non discriminatory and non-judgmental manner".

Information and Education - The policy is however not about dos and donts alone.

It provides for information and education as a basis for prevention and control of HIV.

Employers are requested to put in place "effective workplace HIV/AIDS prevention education" for all persons in the workplace in order to protect themselves and their families from HIV infection.

Such an education policy may be developed in collaboration with agencies of government, workers representatives and other concerned groups.

It must also be participatory by enlisting the full support of persons in and around the workplace.

In addition these, workplaces are to encourage social dialogue based using joint consultation which may culminate in consensus/ agreement.

The role of the ministry of labour and productivity.

The Ministry of Labour is expected to provide technical support for HIV/AIDS policy formulation and implementation in each workplace with the establishment of workplace HIV/ AIDS response technical task teams.

It is the duty of the technical team to "provide technical support and guidance for program formulation and implementation including training, HIV and AIDS education and service provision in the work place".

Grievance Procedure

The policy acknowledges that conflits/disagreements may arise in the handling of HIV/AIDS in the workplace. Therefore, it is recommended that "employers shall ensure that the rights of employees with HIV and AIDS, and remedies available to them in the event of breach of such rights become integrated into grievance procedures".

Employers are also obliged to ensure the confidentiality of the complainant during such proceeedings including ensuring that such proceedings are held in private.

To ensure the success of grievance procedure, employers are expected to create an awareness and understanding of the procedure and how employees can ultilize them.

Legal instrument - The policy which is still awaiting legal backing shall be reviewed every three years and "whenever scientific and developmental concerns so dictate. Enterprises are also expected to encourage a review within the same period.

For now, the legal instrument to back up the policy is contained in the bill on Labour Standards now before the national assembly.

Source: http://allafrica.com/stories/200612070887.html

China's worst hit AIDS province plans HIV tests before marriage

2006-12-04T11:25:00.000+07:00

By, Muzi.com, December 3, 2006

Officials in China's worst hit AIDS province plan compulsory pre-marital HIV tests as part of a series of tough measures to stem the spread of the fatal virus, state media has said.

Yunnan province, in the nation's southwestern border region with the opium-producing Golden Triangle, will start implementing the measures from January 1, 2007, the Xinhua news agency reported.

"The year 2007 is crucial in our effort to contain AIDS," Zhang Chang'an, director of the provincial AIDS control office, told Xinhua.

"The province will do anything in its power to live up to its promise of containing the spread of AIDS."

Yunnan, a major transit point for drug trade in the region, is now home to one quarter of China's officially reported HIV cases.

The province had 40,157 HIV sufferers at the end of last year, up sharply from 14,905 two years earlier, according to official statistics.

The new rules also oblige people diagnosed with HIV to immediately tell their spouses or partners.

"If they don't, the local disease control department has the authority to do it for them," Xinhua said, citing the rules.

Hu Jia, a Beijing-based AIDS activist, said he was concerned about the rights implications of the new rules.

"The Yunnan pronvicial government is simply motivated by what makes life easier for itself but it violates people's right of privacy," he said.

"It's hard to tell whether someone has informed his spouse or partner, and using a law to ensure it happens is definitely not the way to go."

He said the Yunnan rules did not appear to conform with national policy.

China's cabinet in February issues its first detailed national policy guidelines on dealing with the AIDS epidemic.

The rules said that those who seek information and testing should be given the services for free and no department must reveal the identities of carriers of the virus nor personal information about them without their permission.

While in some parts of China, authorities seek to rein in AIDS with free clinics and needle exchange centers, in other parts officials' first reaction often seems to be an urge to seal off sufferers from the rest of society.

State press reported late last year that the southern province of Guangdong plans to build at least two special prisons for HIV/AIDS inmates to cope with an increasing number of carriers who are serving jail terms.

The report was widely repeated in foreign media, and the foreign ministry eventually issued a denial, saying it merely hoped to improve facilities for HIV sufferers in existing jails.

No one has a precise idea of the extent of the AIDS threat in China, but it is widely assumed that the official statistics severely underestimate the true size of the disaster.

The recent drastic hikes in HIV cases in Yunnan, and in China as a whole, may partly reflect the fact that official data are now gradually catching up with reality.

China's health ministry has said 183,733 people were confirmed with HIV/AIDS at the end of October, a 27.5 percent rise from the end of last year.

The number of confirmed cases is significantly lower than the estimate of 650,000 put forward jointly by the government and United Nations health agencies in January.

But Wan Yanhai, a prominent AIDS activist, has estimated the true number could even be 10 times higher than 650,000, based on research by an awareness group he heads, the Beijing Aizhixing Institute.

Source: http://dailynews.muzi.com/news/ll/english/10027907.shtml?cc=13013&ccr=&a=&ccp=1

Compulsory HIV testing before marriage still a sore point

2006-11-13T11:56:00.000+07:00

By, IRIN PlusNews, November 10, 2006

BUJUMBURA - The Roman Catholic Church's policy in Burundi that all couples intending to marry be tested for HIV is raising the hackles of some HIV-positive people, who claim that the measure promotes stigma.

"It is a breach of human rights to force someone to get tested; testing should always be voluntary," said Jeanne Gapiya Niyonzima, a leading AIDS activist in Burundi and the first person in the country to publicly declare her HIV status. "It is good that the church is supporting testing, but this is the wrong way to do it."

In March this year, the Catholic Church in Burundi released a booklet that made the HIV testing policy official.

"We do not require that the couple share their status with us, merely that they get tested and are aware of each other's status," said Father Antoine Sabushatse, spokesman for the Diocese of Bujumbura, the capital city.

He said mandatory testing started in 1989 in the southern province of Bururi, where the Church noticed that many returning soldiers living with the virus married local girls without disclosing their status and passed the virus on to them; the Bishop of the Diocese then began insisting on HIV tests before marriage, a policy that has since spread across the country.

"If there is no openness between a couple; if one hides their HIV status, then the sacrament of marriage is invalid," Sabushatse said.

Gapiya pointed out that priests, however well-intentioned, were not trained HIV counsellors and were unqualified to provide those services. She added that in this day and age, where the vast majority of couples have sexual relations before they get married, testing immediately before marriage was hardly the most effective HIV prevention tool.

"Anyone can pay a crooked doctor for a certificate saying they are HIV-negative; that's easy, and it's done," she said. "These days, people in the community who choose not to get married in church are immediately suspected of being HIV-positive - it is a stigmatising policy."

Sabushatse acknowledged that there had been incidents where one of the parties had presented falsified documents, but said the Church recommended a couple to a doctor known to be trustworthy, who would then have to confirm to the local Catholic priest that the couple had been tested and knew each other's results.

Even if one or both parties were found to be HIV-positive, the Church would still marry them - it was an issue of knowledge and openness, rather than judgment, he added.

Despite the protests, Sabushatse said the response to the testing requirement had been favourable: "Very few people refuse the testing; they have seen a lot of people around them dying and they do not want to take any risks."

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[ENDS]

Gambia: Know Your Status

2006-11-06T17:12:00.000+07:00

By, The Daily Observer (Banjul), November 2, 2006

The toll of HIV/AIDS on our population cannot be overemphasised. And since it is the duty of every responsible citizen, including ourselves, to deal with this horrible disease in whatever ways we can, we have no choice but to continue talking about it - especially to discuss some of the ways in which we can prevent further infection and to find ways of reducing the impact on those already living with the virus.

It is always encouraging to hear leaders from different spheres of life encouraging people to go for HIV testing, because that is one of the ways in which the virus can be contained.

While we are extremely aware that there is more to fighting HIV/AIDS than just taking the HIV test, we feel it is extremely important that each one of us is aware of their HIV status. Knowing one's status saves lives, whether one is positive or negative. It helps to prolong the lives of those living with the virus because they can begin taking the necessary treatment at an earlier time when the disease is not in the advanced stages and thus have more chances of living productive lives.

If a person's CD4 count is still at a reasonable level, there may not even be a need for treatment. A good diet may be enough to enable one living with the virus to live much longer and still lead a productive life. Knowing one's status also helps those who are positive because they will know how to protect others.Those who are negative should try to lead responsible lives and ensure that they maintain their status.

However, all these benefits can only be gained if each one of us is bold enough to know our HIV status. This is why time and again, we passionately encourage everyone to go for voluntary counselling and testing.

With figures already showing that the percentage of people dying from HIV/AIDS related diseases is going down in many Western countries because of anti-retrovival treatment, it is not necessary for people to continue dying as a result of HIV/AIDS. People who are not willing to go for HIV testing will remain an obstacle in the fight against the killer disease.

With the benefit that go with people knowing their HIV status, there is no need for people to remain in the closet, bury their heads in the sand and deliberately refuse to know their status.

The Gambia we want to build is The Gambia of healthy people.

Source: http://allafrica.com/stories/200611020802.html

Botswana testing babies for HIV

2006-11-03T17:08:00.001+07:00

By, News24, November 2, 2006

Gaborone - Botswana will start conducting HIV tests this month on infants aged 16 weeks and above in a United States-funded programme, an official said on Thursday.

"This programme is a result of a partnership between (Botswana's) ministry of health and the US government," said Doug Johnson, an official working here under US President George W Bush's Pepfar initiative.

Pepfar, or the US President's emergency plan for Aids relief, was announced in 2003.

It is a five-year, $15bn plan aimed at combating the disease in more than 120 countries.

Johnson said: "The early-infant-diagnosis programme is going nationwide this month and will be offered in various health centres,".

Infants were earlier tested for HIV at 18 months and above.

Johnson said a pilot project for the early-detection system for infants had been run successfully in the country's north, costing $102 000 (about R755 000).

Aids 'an emergency'

He said Pepfar would allocate an additional $425 000 (about R3.2m) for the national testing project.

A study conducted last year by Botswana's health ministry and the US Centres for Disease Control and Prevention showed that out of 1 917 infants with one or more HIV-positive parent, only seven tested positive.

Botswana's health ministry has called Aids an emergency and says 38.5% of the adult population carries the HIV virus which can lead to Aids.

A 2006 UNAids report put Botswana's adult HIV prevalence rate at about 24%.

Antiretroviral (ARV) drugs, which dent the virus's ability to replicate itself and weaken the body's immune system, are sponsored by the government in what the health ministry says is the first of its kind in Africa.

A total of 68 440 people were receiving ARVs by June this year, the health ministry says. Of these, 59 940 were sponsored by the state.

The government has set a target of 150 000 on treatment by 2009, but has expressed concerns about the costs.

Source: http://www.news24.com/News24/South_Africa/Aids_Focus/0,,2-7-659_2024405,00.html

LESOTHO: Testing campaign struggles to get off the ground

2006-10-24T11:17:00.000+07:00

By, IRIN PlusNews, October 20, 2006

QUTHING - Ten months after its official launch, Lesotho's ambitious plan to take the offer of an HIV test to every village and household in the country has yet to get off the ground.

The original goal of the 'Know Your Status' campaign was to give everyone over the age of 12 the option of HIV counselling and testing by the end of 2007, but it has taken months of groundwork to prepare communities, local health centres and volunteer health workers.

Universal testing may not sound like an unrealistic proposition for Lesotho, which has just 1.8 million people, but in the context of a severe health worker shortage and its largely poor, rural population, many of whom can only be reached on foot or by horseback, the obstacles are considerable.

The campaign has received technical support from the World Health Organisation and financial backing from the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as the United Nations Development Programme and the Global Business Coalition on HIV/AIDS, but much of the US$12.5 million needed to carry out testing has yet to be raised.

Even with the finance in place, there are concerns that a sharp increase in patients seeking treatment - the expected result of the testing campaign - could overwhelm Lesotho's already ailing healthcare system.

"The biggest challenge will be whether the health system is able to absorb people adequately for post-test support," said Nthati Lebona, the campaign's newly appointed coordinator.

VOLUNTEERS WILL CARRY CAMPAIGN

The key to the success or failure of Know Your Status lies with the volunteers, who will do the testing. So far 720 have been recruited, a long way from the target figure of 3,500. "We're covered for the critical areas, so we'll see how far that takes us. If we can't train 3,500 volunteers, we'll make do with less," said Lebona.

Last week, the southern province of Quthing became the third of Lesotho's 10 administrative areas to launch the testing phase of the campaign with an event in the village of Mphaki, high up in the mountains. Members of the national health department made the four-hour journey from the capital, Maseru, to address an audience consisting mainly of school children and tents were erected for testing.

Those doing the testing had also travelled from Maseru. The volunteers recruited to do the outreach work that is to form the backbone of the campaign, had only begun their 10-day training programme the day before.

"We're still putting the infrastructure in place," said the health department's media officer, Lenka Sello. "We're going slowly to give government the chance to scale up treatment. Except for places in the mountains that have no roads, there should be no place that people have to travel more than two kilometres to get ARVs [antiretroviral drugs]."

According to Lebona, 14,000 people are receiving ARV treatment through the government programme, but the WHO estimates that around 58,000 people need to begin treatment.

"So far, people are quite happy with the campaign because we're bringing service to their door," Lebona said. Testing has not reached any one's door yet, although the two-year awareness campaign that preceded the initiative appears to have convinced more people to visit their local clinics to be tested. Lebona estimates that around 100,000 people have been tested in the past two years.

VOLUNTEERS AWAIT FUNDING

Mafeteng District, about 70km south of Maseru, celebrated the launching of its campaign in August, and completed the volunteer training and community mobilisation phases several months ago. According to several volunteers PlusNews spoke to, the only thing preventing them from going out to the villages to begin testing was a lack of funding for transport, tents and rapid testing kits.

"We've been preparing the villages where the clinics are ready to offer treatment," said Qenehelo Sebusi, 25, a volunteer from Mafeteng. The process involves consulting with village chiefs and community members to determine whether they want testing to take place door-to-door or in a centrally located tent. Communities can also choose whether they want the testing to be conducted by local volunteers or, in the interests of confidentiality, by volunteers from elsewhere.

"They keep saying, 'when are you going to start?' because it is now three months since we talked to them, but now the money is not there and we don't know what the problem is," said Sebusi.

Dr Limpho Maile, head of the government's HIV/AIDS directorate, told PlusNews there was enough money for essentials, like test kits and tents, but conceded a shortfall for supporting volunteers with stipends for transport and food.

"We've submitted requests to foreign donors, and the finance ministry is preparing to give us some contingency funding for the stipends," she said. "Most are going to be working in the villages where they live, so they won't need much money for transport but they'll receive a 250 Maluti (US$33) a month stipend."

For now, Sebusi and some of the other volunteers are using this waiting period to practise their counselling and testing skills at Mafeteng Hospital's HIV/AIDS clinic. Most were taking part in the campaign after the experience of losing family members to AIDS, or because of their own HIV-positive status. They did not expect payment, but expressed frustration that they have so far received no support, even in the form of meals.

"We're motivated because we want to help people," said Sebusi, "but we can't help if we're hungry."

THE GREAT TESTING DEBATE

Financial and logistical challenges aside, there are those who question the wisdom of the universal testing endeavour. The initiative has helped fuel the ongoing international debate about the most appropriate approach to HIV testing. Most countries in the region still follow a model that puts the onus on individuals to seek out and request an HIV test.

The persistent social stigma associated with HIV has led to an emphasis on confidentiality and extensive pre- and post-test counselling, designed to protect human rights. But increasingly, doctors, experts and activists in the field of HIV are arguing that these special protocols contribute to the "exceptionalisation" of HIV, further stigmatising the disease.

Others, including former US President Bill Clinton, take the view that in a country like Lesotho, where one in four adults are believed to be infected, universal testing is imperative. "The whole idea is to treat this as a public health problem, not as some source of shame or disgrace, and to keep as many people alive as possible," he said in March.

The Know Your Status campaign includes an awareness-raising component to tackle stigma and educate people about HIV before the offer of a test is made. Volunteers are also supposed to provide pre- and post-test counselling, but the line outside the testing tent in Quthing moved too rapidly for the counselling to be anything but perfunctory.

Campaign coordinator Nthati Lebona believes volunteers should determine when counselling is wanted and needed. "Human beings differ, so we should be flexible about counselling. Some might say, 'Just test me.'"

But Matsepo Lepelesana, of Positive Action, the local AIDS group, said a more uniform approach to counselling is needed if it is to be effective. She also argued that simply having ARVs in place does not add up to adequate post-test support. "Before you go onto the ARVs you have to have information, and I have a concern about whether these people, before and after they test, will receive enough information."

How truly voluntary the testing will be is another concern. In a society where village chiefs still command considerable authority, said Lepelesana, their involvement in the campaign may have the effect of making some community members feel obliged to test.

However when the campaign is eventually implemented, it seems certain that international donor agencies and other countries in the region will be following it closely.

Jim Yong Kim, former director of the WHO's HIV/AIDS department, has predicted that the initiative could yield a 80 percent to 90 percent testing uptake, in which case it could be as effective in reducing HIV infections as a moderately effective vaccine. If he is right, it seems likely that other countries will adopt more proactive testing strategies.

ks/he/oa

Source: Kristy Siegfried/IRIN, October 20, 2006

First Test for Early HIV Infection

2006-10-09T15:35:00.000+07:00

The U.S. Food and Drug Administration has announced the approval of Aptima®, a new assay that can be used to aid the detection of HIV in those who may be newly infected with the virus and cannot yet depend on the results of antibody testing. However, even if Aptima testing yields a positive result, standard antibody testing must still be conducted to confirm the diagnosis of HIV infection.

The Aptima HIV-1 RNA Qualitative Assay, developed by San Diego-Based Gen-Probe Incorporated, is a nucleic acid test (NAT) for the detection of HIV in blood samples. It is intended to be used as an aid in the diagnosis of HIV infection, including acute or primary infection, before the appearance of antibodies to HIV.

A traditional HIV diagnosis is based on testing for antibodies to the virus by enzyme immunoassay (EIA), with positive results confirmed using supplemental antibody tests such as Western blot or immunofluorescence assays (IFA). Although the sensitivity of HIV antibody detection has increased in the last few years with the availability of new assays, a window period between infection and antibody detectability still exists. Following a recent exposure to HIV, it usually takes up to three months for the antibody response to reach detectable levels using EIA testing. Until three months after a possible exposure has occurred, a negative test result using EIA cannot be considered totally reliable.

The newly approved test may provide earlier diagnosis of infection because it detects nucleic acid (RNA) of HIV in a blood sample. In other words, the test looks for the virus itself, not the antibodies produced by the immune system.

The test, however, is not meant to be used as a stand-alone assay for the diagnosis of HIV infection. A positive Aptima test result should be viewed as an unconfirmed test result, indicating probable infection. It should be followed up later with traditional EIA antibody testing to confirm infection with HIV.

Aptima may also be used as an additional test to confirm HIV infection in someone whose specimen is repeatedly reactive for HIV antibodies. This is important because the Western blot can, in some instances, be difficult to interpret and may not always provide a conclusive positive test result. According to the FDA, the Aptima test can be used instead of the traditional Western blot test or IFA for confirming HIV infection when the screening test result for HIV antibodies is positive.

Aptima is different from quantitative HIV assays, better know as viral load tests. Qualitative assays, such as Aptima, detect the presence of viral genetic material and give a "yes-no" answer as to whether the virus is present. In contrast, quantitative assays, such as Roche's Amplicor®, are used to estimate the amount of genetic material present in a sample. Aptima is not approved for quantitative use. Similarly, viral load tests – although sometimes used to diagnose early HIV infection – are not approved for this purpose.

Source: Tim Horn, October 6, 2006 (AIDSmeds)

http://www.poz.com/articles/761_10660.shtml

Rapid HIV Testing Is Beginning to Make a Difference

2006-08-14T15:54:00.000+07:00

Rapid tests could enable more HIV-infected people to know their serostatus and thus to receive early treatment and prevention services. serostatus and thus to receive early treatment and prevention services.

Once HIV-infected people become aware of their HIV serostatus, they can receive treatment and take measures to prevent transmitting the virus.

In 2003, the CDC (Centers for Disease Control and Prevention, United States) launched an initiative to reduce the prevalence of undiagnosed HIV infection by expanding HIV testing, particularly through the use of rapid tests. As part of this initiative, the CDC purchased and distributed 790,310 OraQuick Advance Rapid HIV-1/2 Antibody Tests to 230 organizations in 37 states, the District of Columbia, Puerto Rico, and the Virgin Islands between September 2003 and December 2005.

Among the 372,960 tests administered for diagnostic purposes, results were preliminary positive in 5385 and subsequently confirmed as positive in 4650. Nearly 80% of all individuals with preliminary positive results received the results of confirmatory tests (whether positive, negative, or indeterminate).

In telephone interviews, 48 program coordinators reported that the CDC initiative enabled their organizations to test more clients for HIV but that various challenges (including expired test kits, staff-training requirements, and additional regulations) had delayed implementation of testing.

Comment: OraQuick has excellent sensitivity and specificity. It is the only rapid HIV test using oral fluid to be CLIA-waived and thus usable in nonlaboratory settings. Furthermore, clients can obtain their test results in half an hour, then receive confirmatory testing and referral to care that same day. Unfortunately, the current report fails to mention how many of the 4650 HIV-infected individuals diagnosed through this program actually entered care or eventually received treatment, both of which are much more important outcomes than only receiving test results.

Source: "Journal Watch-Medicine that Matters" August 13, 2006

Malawi holds first HIV test week

2006-07-17T12:21:00.000+07:00

July 15, 2006.

By Edward Kankhomba

The National Aids Commission says the week offers an opportunity to over 50,000 people to know their HIV status by the end of the week and facilitate change in risk behaviour and link persons to other HIV and AIDS services.

Malawi is still grappling with one of the most devastating HIV and AIDS epidemics in this part of Africa. In the past few years Malawi has expanded and accelerated its response and has been able to diversify both interventions and organizations participating in this response. With advent of treatment and programmes to prevent vertical transmission of HIV testing has become a major part of the prevention and care continuum.
However,Director of policy and Programing in the National Aids Commission (NAC) Roy Hauya said a lot more work needs to be done in testing. We know that of its 10 million people, of which 6 million are sexually active, only 15 percent have tested for HIV and know their status.
In a statement released to all media houses,Hauya said Malawi has 930,000 people that are living with HIV, but the majority are unaware of their HIV status. "This situation poses a great threat to prevention efforts and results in missed opportunities by many HIV infected Malawians to access care and support services", He said.
The National AIDS Commission, Ministry of Health, development partners and non-governmental organizations have organized a National HIV Testing Week from 17th to 22nd July 2006 to benefit many Malawians who have not tested for HIV.
The Commission said the event is expected to mobilize all communities and offer individuals and couples an opportunity to test for HIV and be counselled. The activity has been designed in line with the National HIV and AIDS Policy and it contributes significantly to the implementation of the national efforts at scaling HIV testing and counselling and to achieve the goal of testing one million people by the end of 2007.
Hauya said the week among other things offers an opportunity to over 50,000 people to know their HIV status by the end of the week and facilitate change in risk behaviour and link persons to other HIV and AIDS services
The campaign will target men, women and young people of reproductive age group 15-49 years. Youths and married couples in this age group will particularly be encouraged to test. However, access for those aged above 49 years or children below 14 years will not be limited. According to policy, children below 14 years will be allowed to test if accompanied by a guardian and they give consent.
HIV testing sites have been set up to take an increased number of clients. Additional counsellors have been trained and mobilized and all supplies, notably rapid testing kits, have been distributed to districts. There are currently 239 such sites countrywide, but depending on demand each district will set up additional outreach or mobile sites at places like markets, schools, churches or mosques. All testing sites will be required to meet minimum operational and infection prevention standards. At the same time each site will make referrals for management and further support as need be.
Assemblies, district health offices civil society organizations will mobilize all trained counsellors to work full time during the entire week. Currently there are 963 trained HIV counsellors nationwide, 543 of them working full time and 420 on part time. Testing will be voluntary and anonymous. Those testing positive will be linked to available post-test care and support services within their districts.
It is expected that even after the campaign all sites will continue providing full time services to serve those who were not able to access the services. This will take care of negative clients who may have been in the window period and wish to be re-tested after three months.
While this national testing and week is the first of its kind in Malawi, the plan is to make the event annual in order to continue to mobilize communities and to give opportunity to individuals and couples to know their HIV status.

Source:// African News Dimension

AIDS council in Zambia calls for more voluntary counseling

2006-07-01T12:35:00.000+07:00

Zinhua, June 30, 2006

Zambia: An official with Zambia's National AIDS Council (NAC) has called on people to go for Voluntary Counseling and Testing (VCT) bemoaning the current level of testing rates for HIV in the country is too low to sufficiently combat the disease.

Program Director Alex Simwanza said it was important that many people know their status if the fight against HIV/AIDS were to be won.

"Currently, statistics show that despite our high sustained prevalence levels of HIV infection which is 16 percent, only 1.5 million of our (10 million) population have been tested, which is too low," Simwanza was quoted by Friday's The Post as saying.

"It is important that more people go for VCT and know their status so that whichever side they find themselves on, they will be able to take precautionary measures," Simwanza said.

"Knowledge in the fight against HIV/AIDS is power," he added.

Simwanza appealed to those who do not know their status to utilize the VCT Day that falls Friday and make a difference in their lives and their families lives.
"Testing and counseling play a critical role in HIV prevention by helping people to cope with the disease and avoid infecting others," he said.

He said the prevention of HIV needs a multi-faceted and integrated approach that could reach the widest possible number of people with a mix of information and services.

The fear of discrimination and stigma had prevented people from testing for HIV, Simwanza said.

He however pointed out that thanks to the availability of free treatment that allows people with HIV to continue living and feeling well for many years, there have been more people opting to be tested.

"The availability of treatment has generated hope because of an underlining close linkage between testing, treatment and prevention," Simwanza said.

Source: Xinhua

South Africa: Judge Challenges HIV Counselling

2006-05-21T09:48:00.000+07:00

Health-e, Cape Town, By Kerry Cullinan, May 4, 2006

South Africa--HIV tests should be routine in health institutions that offer AIDS treatment, says Judge Edwin Cameron. Counselling before an HIV test discourages people from testing and is a barrier to AIDS treatment, according to one of the country's leading AIDS activists.

In a provocative address to University of KwaZulu-Natal (UKZN) students yesterday (Thurs 4 May), Judge Edwin Cameron said that extensive pre-test counselling had been appropriate in an era where there was no treatment for AIDS and HIV positive people faced little but discrimination.

"But we now have a mass epidemic where mass treatment is also possible, so extensive pre-test counselling may be a luxury we can no longer afford if we are to reach everyone who needs treatment," said Cameron.

Health workers should be able to routinely test patients for HIV in places where AIDS treatment was available, there was no discrimination and patients' HIV status was kept confidential, said Cameron.

"When a person is suspected of having breast cancer, their doctor does not have to counsel them extensively before testing them for cancer," said Cameron. Before AIDS treatment had become widely available, human rights activists had "exceptionalised AIDS", he said. Extensive counselling was one of the protective measures "designed in a world where an HIV diagnosis meant discrimination".

"The challenge we now face is to normalise AIDS treatment," said Cameron. "Where treatment is available, exceptionalising AIDS impedes treatment. There is no reason why AIDS should be treated differently from breast cancer or any other disease."

In Botswana, where antiretroviral treatment has been freely available since 2003, HIV tests without counselling are routine at clinics and hospitals unless a patient refuses to have a test.
Cameron was speaking at a memorial meeting for UKZN law lecturer Ronald Louw, who died almost a year ago of AIDS.

Describing Louw as an "eloquent, informed, AIDS-literate man", Cameron said he believed Louw was too afraid to take an HIV test until it was too late because of a sense of "inner shame".
Louw was diagnosed with HIV when he was admitted to hospital less than a month before his death. This was despite the fact that friends concerned about his health had asked him to go for an HIV test some two years before his death.

"Ronald died of a paralysing dread of confronting HIV. He was unable to take constructive action to seek life-saving treatment because he lacked internal self-acceptance," said Cameron.
Cameron added that he had also visited St Mary's Hospital outside Durban, yesterday. Despite the fact that the hospital had a renowned AIDS clinic, staff were dying of AIDS because they were too afraid to get tested, he said.

"Internal self-acceptance [of AIDS] has nothing to do with educational levels or sophistication. It is an emotional, human thing. Pre-test counselling may feed into the internal stigma and mean
that people who need treatment refuse to be tested."

Souce: AllAfrica.com

Viet Nam: Voluntary HIV testing project launched

2006-05-21T09:41:00.001+07:00

April 27, 2006, Viet Nam News Service

HA NOI — HIV voluntary counselling and testing (HIV/VCT) plays an important role in the prevention of HIV/AIDS, said Nguyen Huy Nga, director of the Health Ministry’s HIV/AIDS Department, at the signing ceremony for the Mekong Regional HIV/VCT Project in the capital.

Since Viet Nam still experienced discrimination against HIV/AIDS patients, the project is all the more important, the director said, promising his department’s support for the project being carried out by Marie Stopes International Viet Nam (MSIVN).

Lauding the HIV/VCT work done earlier by MSIVN and their experience in treating patients, Dr Nguyen Duc Anh said, "Our patients feel more comfortable and face no discrimination at MSIVN’s HIV/VCT programme."

Other than HIV/VCT, MSIVN’s clinic also provides other services such as reproductive health counselling and treatment, benefiting female patients, the doctor said.Anh added that sex workers, especially those working the streets, required this service more as they travel frequently and have no other facility to check for HIV/AIDS and treatment.

Such clients, who have the potential for spreading the disease, would find the clinics safe.Dr Om Chhorvoin, the project’s regional director, said they would carry out the service not only at the MSIVN but also in other clinics to serve the clients.

Together with China and Indonesia, Viet Nam is a nation with a high growth rate of people having HIV/AIDS among groups such as addicts, prostitutes and homosexuals.

According to Viet Nam’s Department of HIV/AIDS, there are over 100,000 people having HIV/AIDS, including more than 17,000 AIDS patients and 13,000 newly-infected cases.
Nga said though Viet Nam had reported a reduction in newly-infected cases from 17,000 in 2002 to 13,000 in 2005, the country was still at risk if no effective control was in place.

Relevant agencies could not even update the count of HIV/AIDS patients in Viet Nam as many were not aware if they were carrying the disease, rendering the fight against the dreaded disease more complex, Nga said. "Our current figure may represent only one third of the real patients," he said.

The MSIVN clinic would remove the inhibitions of patients who refuse to go to specialised HIV/AIDS testing centres for the fear of being discriminated.With three years experience in this service, MSIVN have pledged to provide their patients with friendly, helpful, high quality, safe and secure service. Furthermore, the project aims to increase awareness among the public about HIV/AIDS.

Nguyen Bich Hang, director of MSIVN, asked domestic and international agencies and organisations to support the project and the fight against HIV/AIDS. — VNS

Source: Viet Nam News Service Online

LESOTHO: 'Know your status' drive needs $12.5m and people's cooperation

2006-04-11T03:05:00.000+07:00

IRIN, April 6, 2006

MASERU, 6 April (IRIN) - The success of Lesotho's plan to increase access to HIV/AIDS treatment will depend on a national commitment to being tested for the virus and a R75 million (US $12.5 million) financial boost.

Motloheloa Phooko, Minister of Health and Social Welfare, said at a press conference on Wednesday that "the money needed will be used in the two years of the campaign to mobilise people to know their status - but getting the money alone will not make the campaign a success unless Basotho [Lesotho people] own up to the programme and get tested".

Lesotho's 'Know Your Status' campaign, the first of its kind worldwide, will offer confidential and voluntary HIV testing and counselling with the aim of reaching all households by the end of 2007.

The funds will be used to employ counselling and testing personnel, print educational material and purchase vehicles for the campaign.

With an adult prevalence rate of 23.2 percent in a population of 1.8 million, it is estimated that 265,000 people in Lesotho are living with HIV/AIDS, and 49,400 are already in need of life-prolonging antiretroviral (ARV) treatment.

The number could be higher, as national statistics indicate that only 72,000 people have been tested to date, with less than 10,000 receiving ARVs.

Despite massive HIV/AIDS campaigns, very little behavioural change had been observed, Phooko said.

The programme, launched by the King on World AIDS day in 2005, will use the same model employed by immunisation programmes: extensive community mobilisation and education, followed by door-to-door visits.

Communities will decide how and when their members will be offered HIV/AIDS testing and counselling, and independent people's committees will be established at local, district and national level to ensure that testing is always voluntary, confidentiality is maintained and post-testing services, including treatment, are provided.

Lesotho has been testing and treating people free of charge at all hospitals, and plans are underway to make ARV treatment available at all community clinics.

Jim Yong Kim, Director of the World Health Organisation, praised the Know Your Status campaign last year, saying, "Lesotho's initiative is an excellent example of this global trend towards expanding and integrating prevention and treatment efforts. Many nations like Lesotho are now empowered to develop exciting, bold programmes that directly confront the epidemic."

Source: Reuters AlertNet

Malawi: Police Press for VCT Centre

2006-03-27T05:36:00.000+07:00

By HAPPY SAKA, The Chronicle Newspaper, March 20, 2006

Lilongwe--Senior Police officers in Lilongwe are pressing warning buttons on government and non-governmental organisations (NGOs) to immediately assist them with a voluntary counselling and testing centre (VCT) so that the officers and their families have access to information on sexual and reproductive health as well as HIV.

Some police officers told The Chronicle in an exclusive interview recently that there is need to establish a VCT centre at the regional office in Lilongwe where people can be tested for HIV/AIDS and get information on sexual and reproductive health.

"We would like to ask government and some other well wishers and non-governmental organisation to give us support so that we can have a VCT centre which will be providing us information about sexual and transmitted diseases and HIV/AIDS testing," said one of the police officers.

The officers said many police officers are dying of HIV/AIDS and said government should do something to save their life. "Its true that police officers are dying of sexually transmitted diseases including HIV/AIDS every month and this is because we do not have a VCT centre in most of the police stations in Malawi.

Even here we don't have a VCT centre, yet this is a police regional head quarters," he said".
The officers also disclosed that most of the police officers in the country are always shy to visit government or private hospitals to get treatment of sexually transmitted diseases.

"It is difficult for police men to go for STI treatment in government hospitals because they are embarrassed, that's why we are insisting that we should have a VCT centre so that it will be easy for us to get treatment," said the officers.

The regional HIV/AIDS-coordinator for central regional police, Fredrick Semfoliano confirmed in a separate interview recently that the VCT centre is indeed needed at the regional. "I can confirm to you that it's true that we don't have VCT centre here which can treat sexual and transmitted diseases including HIV/AIDS.

We have been pushing this issue to the headquarters in area 30 and it seems like they are working on it," said Semfoliano who could not shade more right on the issue.

He further said it has been always difficult for most of the police officers, more especially those that are affected to go to a near by hospital or the right house to get anti-retroviral drugs, (ARVs) and information about sexual and reproductive health.

He also said the coming of a VCT centre would help many police officers to have knowledge on how they can prevent sexually transmitted diseases.

"We have tried our best to disseminate information about HIV/AIDS but we have not yet tackled much of the issue about sexual and reproductive health. We feel if we can have a VCT Centre, many police officers will be able to visit the centre since it will be close to them and the living life standard can change as well.

However, National AIDS coordinator for police, Edward Chatsalira said in an interview that the issue has already been put into consideration and plans are underway to construct a VCT centre at the stations.

"Yes we have received the information about the need for a VCT centre and at the moment we are planning to talk to city assembly officials so that they can give us land to construct a good VCT centre," he said Chatsalira added: "We need to train counsellors who will be treating the officers and this will be done after we have sourced some financial assistance from donors," he said.

Asked to comment on the issue of police officers dying of HIV/Aids and sexually transmitted diseases, Chatsalira sounded ignorant on the issue saying he needs time to cross check figures at his office.

The investigations conducted by this reporter have reviewed that the Malawi police service has only two VCT centres, one in Zomba and the other one at the police headquarters in area 30.

The VCT centre which is in area 30 has been treating sexual and transmitted infections and providing information about HIV/AIDS and family planning methods.

The investigations have also reviewed that the police service is planning to establish VCT centres in all major police stations namely, Blantyre, Mzuzu and Mtakataka in as one way of reducing sexually transmitted diseases in the police service.

Source: AllAfrica.com

Kenya: Stalking the Aids virus in Samburu District

2006-03-24T23:36:00.000+07:00

Kenya Daily Nation Newspaper, by Arthur Okwemba Publication 3/23/2006

Kenya--With only a bag, a file and a pair of strong legs, Daniel Ebongon traverses the width and breath of Samburu District hunting for the Aids virus.

Ebongon, known locally as the 'Hunter' has since December tested 231 people for HIV, giving a full new meaning to mobile VCT.

Today, when we caught up with him, the Hunter, had just walked over 25 kilometres to Lolkuniani in Wamba division, where several Samburu herdsmen and women had converged for the market day.

"This is one day I never miss, it offers a unique chance to meet a big group of people and possible clients," says Ebongon, who works for the Nomadic Community Trust.

As the people go about trading, the Hunter moves amongst them talking about the importance of knowing their HIV status. Some who have not heard of the virus are suspicious of his activities and rarely warm up to his messages.

On the other hand, those who agree to be tested are moved a few metres from the crowd where he counsels them, before carrying out the test. Within 30 minutes, the clients get their results.

Some who are willing but too busy trading have to be waited for, sometimes for as long as six hours when they are through with business. But yet others who are too busy have to be booked for the next market day. Even with all this difficulties, Ebongon is able to test three to four clients on every market day.

During other days, he moves to various homesteads educating the pastoralists about HIV and testing any who are willing. Although it has been difficult to cover a larger area, Ebongon will not be the only one walking around this area in the coming months.

Recently, the United Nations Population Fund, which has been funding activities on the prevention of HIV/Aids in the district, has trained people who will, among things, carry out mobile VCT work. At the moment, there is an innovative condom distribution system, which is supposed to work hand in hand with the mobile VCT strategy.

Because of the pastoralism lifestyle, UNFPA is facilitating the distribution of condoms through dispensers placed on tree branches along strategic routes. This enables men to pick these condoms as they go about their daily activities.

"The best strategy to intervene in the prevention and management of HIV/Aids in areas like Samburu is coming up plans that fit well with the way of life of these people," says Judy Karogo of UNFPA.

With the walking VCT and condom dispensers patched on trees, there is hope to reduce HIV prevalence from the current 8.1 per cent. "But easier said than done," says Ebongon

At times when he goes for a prior appointment he might find the client has moved, in which case
he has to track them down– a herculean task.

The other challenge is that people are demanding to be given ARVs before they agree to be tested. The situation becomes more difficult as those found to be HIV positive constantly follow him wanting to be provided with the drugs.

Although some of the hospitals in the district have ARVs, those infected have to walk for over 50 kilometres to reach the nearest centre.

A number of his clients who came for pre-test counselling have failed to return for post-test counselling; while others have never returned for another test after the three months window period.

The situation is equally difficult for him when he tries to convince his relatives friends and acquaintances to be tested. "Some of these people fear that confidentiality will be compromised and would rather have the test done by a stranger."

Despite all these difficulties, mobile VCT centres are being touted as the best strategy in reaching out to as many people as possible in the rural areas and communities living in extreme remote areas.

In a recent interview, Dr Kevin DeCock, former director of the US Centres for Disease Control in Kenya, said establishing VCT centres in areas where people are dispersed was going to be a waste of resources.

He argued that the use of mobile VCT centres which are operated by people not from the community where the tests are being done would be the best way forward.

Source: Kenya Daily Nation

Routine Testing Helps Botswana Track the Spread of AIDS

2006-01-31T05:30:00.000+07:00

Voice of America, 1/26/2006

The World Health Organization estimates that less than 10 percent of Africans with HIV/AIDS know they are infected.

This -- despite decades of public education campaigns. WHO officials say such is the case in Botswana, which is estimated to have a high rate of infection.

In order save lives, AIDS treatment is free. But before people can be treated, they must be tested, and many are afraid to go for voluntary testing.

The WHO says as a result, the number of people receiving treatment is less than expected.

Three years ago this month the government came up with a new policy of routine testing in clinics.

Segolame Ramotlhwa is operations manager for the national HIV/AIDS treatment program known as MASA, or New Dawn.

He told VOA’s Ruby Ofori that the new program does not violate patients’ rights: “When patients come to our health facility all of them are offered and then if they agree to the test then they are tested. So it’s not like anybody is forced. ”

Mr. Ramotlhwa said as a result of routine testing more people are receiving anti-retroviral drug therapy.

“An important step towards fighting the epidemic is for people to know their HIV status. When they know their HIV status they’re somewhat empowered because now they know what they can do, and there’s something that the state can do for them.”

Source: VOA News.com

Muddling the message- VCT

2006-01-31T05:19:00.000+07:00

by Kristin Palitza, Mail & Gaurdian, 24 January 2006

South Africa- Patience Mavata counsels an HIV/Aids support group at the Ikhaya Lobomi hospice in the Valley of a Thousand Hills in KwaZulu-Natal.

Voluntary counselling and testing (VCT) services are meant to help HIV-positive people cope with the disease, but some counsellors are doing more harm than good, particularly in KwaZulu-Natal.

Nurses, NGOs and Aids activists in the province say many HIV-positive patients could live healthier and longer lives if provided with better information about the virus and their treatment options.

Instead, they say, the VCT process leaves many feeling helpless and adrift.

Patience Mavata is a nurse who runs the Ikhaya Lobomi Aids hospice in the Valley of a Thousand Hills in KwaZulu-Natal, the province with the country’s highest HIV-infection rate, at 36%. She says many counsellors continue to tell patients that HIV is a death sentence.

“People lose hope because counsellors are so negative... counsellors kill people’s spirit.” And as a result “people die earlier than they should due to emotional stress,” she claims.

Mavata often admits patients to Ikahya Lobomi who have gone through the VCT process at public hospitals or clinics. They tell her that they were given their test results but no medical or nutritional advice.

Many are sent home knowing they are HIV-positive but not knowing what to do next.“We are concerned about the quality of VCT,” says Sifiso Nkala, Treatment Action Campaign (TAC) provincial coordinator in KwaZulu-Natal.

“Bad counselling does not only discourage people, it isolates and creates a stigma.” Nkala says many HIV/Aids counsellors do not have appropriate referral systems in place to help HIV-positive people access support groups, manage opportunistic infections or understand anti-retroviral (ARV) treatment.

And, he adds, counsellors often have insufficient medical knowledge about treatment options and side effects of ARVs. Poor quality HIV/Aids counselling might also be one of the reasons for the low uptake of VCT services.

In the past four years, only 850 000 South Africans out of a population of almost 45-million have been tested for HIV, according to the United Nations Development Programme. The problem is not unique to South Africa -- the World Health Organisation (WHO) estimates “fewer than 10% of people in African countries at the epicentre of the pandemic know their status”.

Mavata says counsellors often fail to inform patients about the need for CD4-count testing or how and when to access ARV therapy. As a result, many HIV-positive people go for CD4 testing too late for ARV therapy to be effective. HIV-positive persons with a CD4 count between 50 and 200 are eligible for ARV therapy.

If a CD4-count has dropped below 50, the immune system is too weak to deal with the powerful drugs and doctors will try to boost patients’ CD4 count with better nutrition or antibiotics. But many counsellors are unable to provide any useful nutritional information.

“Counsellors use the term ‘balanced diet’ but many are unable to explain what it truly means,” says Zanele Mjoka, community development facilitator at the National Association of People Living with HIV/Aids (Napwa) in Durban.

She says she often receives calls from distressed and hopeless clients who said they had not found pre- and post-test counselling, particularly that offered in public hospitals, to be helpful.

Mjoka believes staff shortages and heavy workloads are largely responsible for the poor quality of counselling. She says that in order for counselling to be done properly, counsellors should see no more than five clients per day.

“Otherwise they rush people through,” she explains. In public hospitals and clinics, counsellors deal with 15 to 20 patients a day. She adds that the Department of Health needs to ensure counsellors are debriefed on a regular basis to deal with the emotional strain of their jobs.

Many public sector counsellors receive insufficient training and the 10-day training course offered by the Department of Health is too short to prepare them adequately for the job, says Mjoka. According to the health department’s website, it employed 887 counsellors at 474 VCT sites across the country in March 2002, but does not provide any updated numbers.

Department of Health spokesperson Daphney Lebethe said the department’s database showed that about 12 000 counsellors had been trained, but could not provide a breakdown per province. She said the department also provides refresher courses for practicing counsellors at provincial, district and local level.

Poor quality counselling also increases the risk of mother-to-child transmission of the virus. Research conducted last year by the Medical Research Council, Health Systems Trust and the University of the Western Cape found that counsellors failed to communicate all the facts women needed to make an informed choice about infant feeding and to practice that choice safely.

The study found that only a third of the women who chose to use milk formula were given instructions, and none of the women who chose exclusive breastfeeding could define what the term meant.

Research has conclusively shown that, apart from the actual process of birth, the highest risk of HIV transmission comes from combining breastfeeding and formula feeding.

“Counsellors have the power to influence the life of an HIV-positive person in a very positive or very negative way,” says Mavata.

Source: Mail & Gaurdian online

Botswana's AIDS program confronts stigma, fear- Drugs provided free, but getting people to agree to be tested is hard

2006-01-07T07:55:00.000+07:00

Associated Press, January 5, 2006

GABORONE, Botswana (AP) -- When Botswana first offered free AIDS treatment, health authorities in one of the world's most infected countries braced for a rush. It didn't come.

Most people were still too afraid to get tested for the deadly scourge.

The startling reluctance to seek help in one of the few African nations able to provide it prompted a radical rethink of how testing is done here. An HIV test is now offered as a routine part of any medical visit.

In most countries, patients are left to ask for a test themselves, then put through extensive counseling to prepare them for the outcome. But despite decades of education campaigns, World Health Organization officials estimate fewer than 10 percent of HIV-infected people in the African countries at the epicenter of the pandemic realize they have the virus that causes AIDS.
Botswana's decision to start routine testing initially caused alarm among international health advocates, who worried that patients' rights to confidentiality and informed consent would be compromised.

"I think the first right of a human being is to be alive. All other rights are secondary," countered Segolame Ramotlhwa, operations manager for the national treatment program dubbed Masa, or New Dawn.

He argued confidentiality was being confused with secrecy, making doctors reluctant to even suggest testing for a disease that has infected more than a third of Botswana adults.

Doctors here believe pulling patients aside for special counseling is intimidating and helps fuel the stigma that keeps patients from seeking help.

Dr. Howard Moffat, medical superintendent at Princess Marina Hospital in the capital, Gaborone, said people who were not sure they wanted to know their HIV status often emerged from counseling determined not to be tested.

"I think the medical profession itself ... played a major role in creating this fear of AIDS and this quite irrational reluctance to be tested," he said.

Waiting too long to be tested
Since the beginning of 2004, Botswana has treated HIV tests like any other medical procedure. Patients have the option to refuse, but doctors say most don't. They estimate up to 35 percent of the 1.7 million population now know their status.

If the outcome is negative, a health worker will briefly reinforce the importance of staying that way. If it is positive, the patient will receive help to manage the condition and treatment when needed.

Most people only see a doctor when their symptoms are severe, by which time it may be too late. It takes three to four times more resources to save someone who arrives on a stretcher than someone who is still on their feet, Ramotlhwa said.

When Kelatlhilwe Segole was pregnant, she was not offered an HIV test and unwittingly passed the virus to her daughter, now a 7-year-old. Both are now on treatment, but her husband refused to be tested until he was in a wheelchair.

"I kept telling him, he will die because of not knowing his status," said the fragile-looking 27-year-old, as she waited in a daylong line for her medicine.

Much of the emphasis on voluntary testing and counseling came from HIV's early association in the United States with homosexuality, which is widely taboo in sub-Saharan Africa, home to more than 60 percent of the estimated 40 million infected globally. This became the international standard, even though HIV is now overwhelmingly a heterosexual disease that killed 2.4 million on this continent last year alone.

Life-prolonging anti-retroviral medicines that have turned HIV into a manageable chronic condition in wealthier countries remain out of reach for all but a handful in Africa. They are expensive, and most countries lack the medical staff and infrastructure to dispense them widely.
Botswana was the first country to offer free medicines to all who need them in 2002. It now has half the estimated 110,000 in immediate need on treatment.

Botswana rights activists agree on the urgency of reaching the other half, but worry many consent to a test without being prepared. There is a cultural reluctance to question doctors here.
A study of antenatal clinics in Botswana's second city, Francistown, found 90.5 percent of women tested for HIV in the first three months of the new policy, compared with just over 75 percent in the last four months of the voluntary approach. Many, however, failed to return for their results.

"At the moment it seems like a numbers game, a total drive to get people to know their status. The question is then what?" said Christine Stegling, of the Botswana Network on Ethics, Law and HIV/AIDS. "I have a feeling that what is happening is health care providers are getting out of communicating meaningfully with their patients."

The new approach is more likely to reach women, who are more frequent visitors to health services because of pregnancies. Men continue to be underrepresented in Botswana's treatment program.

Stegling believes testing numbers are going up in part because people are starting to see the effects of treatment.

WHO and UNAIDS now encourage routine testing in all HIV-prevalent areas where anti-retrovirals are available. But for millions, a positive result remains a death sentence.

Source: CNN.com

Nigeria: HIV/Aids- Treatment Now the Issue

2005-08-08T15:54:00.000+07:00

By Agha Ibiam,, This Day, August 4, 2005

LAGOS-- Chief Executive Officer, Lagos State AIDS Control Agency, Dr. Aderemi Desalu has the challenges they now face are that of providing proper treatment for people living with HIV/AIDS (PLWHA).

Desalu disclosed this at the HIV/AIDS Development Programme Project, on Expanding Public Sector Response, organised by the Lagos State Ministry of Health in collaboration with the World Bank. He stated that the State has gone through the stages of informing the people about HIV/AIDS, adding that about 90 per cent of people living in Lagos are aware of the disease.

He said one of the greatest challenges they met on ground was the issue of voluntary counselling treatment centre (VCTs), where people affected with HIV/AIDS could get tested and at the same time receive drugs if satified positive.

"The last thing the State is trying to get hold of is the treatment aspect. It is not everybody who is positive needs anti-retroviral treatment. So what we have in Lagos State is both Federal and State Government VCTs. We urge people that they should not allow HIV scare them into submission. They should come out, get tested because if they tested and a later need medication, it would be available to them", he said.

Desalu said current estimate revealed that out of the 15 million people living in Lagos, about one million of the population are HIV positive. That again presupposes that 10-15 per cent of them, that is 100,000 or more may need ARVs.

He said the need to scale up the provision of ARVs for those that need it is necessary, which he said cannot be done in isolation. He said about 15,000 are on treatment under Federal Government initiative, while another 15,000 are on ARV under aegis of PEPFAR, while another 20,000 is under Lagos State treatment record.

"The challenge that has been thrown to everybody is re-echoed by President Olusegun Obasanjo recently. And this is an international challenge that we need to put at least 250,000 people by June next year", Desalu said.

He reiterated that the idea of treating 3 million people by 2005, as postulated by the World
Health Organisation (WHO) is unrealistic. He said for Lagos State to meet the new challenge, it is just a matter of expanding VCTs centres and training of more personnels.

Source: AllAfrica.com

Zambia: Mazabuka VCT centers inadequate

2005-08-05T15:00:00.000+07:00

Zambia News Agency, August 3, 2005

Mazabuka—Health Authorities in Mazabuka have complained over the inadequatel number of voluntary counseling and testing (VCT) centres in the district.

District director of health Francis Bwalya said the district only has seven VCT centres against a population of 242,000 people.

Dr. Bwalya said there is need for non-governmental organisations involved in HIV/AIDS programmes to open up VCT centres to enable more people have access to counseling and testing services.

He said the district has two ARV centres where over 200 people are currently receiving ARVs.

Source: Zana

Ghana: National HIV Testing Day?

2005-08-02T09:44:00.000+07:00

by Eunice Menk, Accra Daily Mail, August 01, 2005

With inflows of donor monies into developing countries to fight HIV/AIDS, including those of President Bush's 15 billion-dollar initiative and the Global Fund for Malaria, Tuberculosis and HIV/AIDS, there are now possibilities of scaling up prevention activities to stop the spread of the pandemic and prolong the lives of infected persons through access to treatment.

Finding a cure or vaccine may be years away, but HIV/AIDS is no longer considered insurmountable, with so much resources pouring in. Experts are now saying there is the need to raise the profile of voluntary HIV testing and counselling because there is certainly life after getting tested.

Indeed the possibility of living longer after testing positive is becoming brighter and brighter.

According policymakers and some health experts, an expanded HIV testing and counselling are increasingly becoming "an urgent policy imperative for HIV/AIDS control in many developing countries."

International agencies such as the World Health Organisation (WHO) and the UN Agency in charge of HIV/AIDS are also lending their support to calls for expansion of testing. Some countries in Africa have gone ahead to introduce an expanded HIV testing and counselling.

The Botswana government in 2004 introduced an expanded HIV testing and counselling model.
Similar moves are being considered in other African countries. But are these African countries including Ghana ready to take on the challenge of expanding testing?

This would involve meeting the operational costs of expanded testing and counselling services, strengthening health systems, making available anti-retroviral drugs (ART) in large quantities and developing a legal and policy framework to deal with stigma among other critical issues. No doubt, there are huge benefits to be derived from knowing one's HIV status at the individual and country level.

For the individual, there is evidence that knowledge of one's HIV status could change high-risk behaviour and reduce subsequent HIV transmission. For countries, the early identification of HIV infection, through testing and counselling on a large scale, is increasingly becoming key in the provision of treatment, care and prevention.

Mr Terje Anderson, Executive Director of the National Association of People Living With HIV/AIDS (PLWHA) in the United States, in discussions with some African journalists in June this year, who were on an HIV/AIDS reporting tour of the United States, said it was possible for countries such as Ghana to replicate the US National HIV Testing Day in their countries.

The Association of PLWHA in the United States took a lead role several years ago to establish a National Voluntary HIV Testing Day, marked every June 27 across the US.

According to these frontrunners, not only is there life after testing, but also there is an opportunity for social mobilisation in raising the profile of HIV testing. To them people must overcome fright, get tested and live positively with the disease if infected and avoid infection if virus-free.

But which way should African countries go? Should they scale up HIV testing through establishing a national HIV testing day or settle on just expanding voluntary and counselling centres (VCT).

Or should testing be part of routine health care for any one who visits the health facility or a diagnostic HIV testing for patients seen at health facilities, who must get tested when their symptoms create concern in the minds of health workers. Which way should it go? There are some concerns all aimed at ensuring that raising the profile of HIV testing did not create more problems.

For one thing, many countries still have policy gaps in dealing with stigma, discrimination and abuse of the rights of PLWHA.

The weak infrastructure of most developing countries to offer treatment has also been called into question.

According to Dr Robert Simonds, Acting Deputy Director for Programmes, Global AIDS Programmes at the Centres for Disease Control in the US, in discussions with the African journalists said it was becoming necessary to routinely test pregnant women and patients, who visited health facilities as part of the preventive strategies.

He said some countries were beginning to introduce a policy to conduct HIV testing on tuberculosis patients and pregnant women at health facilities.

Dr Simonds said in this age of rapid testing for the disease, it was easy to expand VCT to cover larger segment of the communities to ensure that the disease was controlled and properly managed.

According to him, treatment and curbing the spread of the disease depended on knowing the extent of infection and, therefore, HIV/AIDS testing was very important in all aspects of intervention.

Professor Awuku Sakyi Amoa, the Director-General of the Ghana AIDS Commission, in an interview with the Ghana News Agency in Accra, said Ghana was already involved in expanding HIV testing. He said although Ghana had no specific day set aside as a national HIV testing day, the whole of November, yearly, has been set aside for free testing during which period resources were given to all the regions in the country to go ahead with the programme.

"Currently there are 96 voluntary, counselling and testing sites throughout the country", he said.

Policy makers had said it had also become clearer that competent and responsible expansion of HIV testing and counselling services required meeting several challenges.

A January 2005 document of the US-based Centre For Strategic and International Studies, on "Expanded HIV Testing" said as a starting point, political and health leaders needed to "acknowledge, opening and forcefully, the essential linkages between expanded testing and counselling and the ability to provide antiretroviral treatment (ART) and prevention on a large scale."

It said there was the need to also ensure the protection of tested individuals from stigma, discrimination, and abuse.

According to the document, national leaders needed to meet the operational cost of expanded testing and counselling and to incorporate this factor into strategies and budgets for battling the disease.

"The health infrastructure in most African countries are weak and that has first to be strengthened if effective testing and counselling is to be provided on a large scale."

"Perhaps most importantly, leaders have to mediate two important concerns: Encouraging increased awareness by individuals of their HIV status in order to provide expanded access to
ART while also ensuring the protection of tested individuals, from stigma, discrimination and abuse," the document said.

Would Ghana and other African countries have adequate supplies of ART for those who would test positive?

Prof Sakyi Amoa told the GNA that there were currently four sites including the Korle Bu Teaching Hospital providing ART and this was going to be scaled up to ensure that all regional hospitals provided ART by the end of 2005.

He said treatment was to be expanded and by 2007, about 50 per cent of districts would be involved in administering ART.

Prof. Sakyi Amoa said with the scaling up of VCT centres there was no likelihood of people rushing for ART and, therefore, the question of short supplies of ART might not arise since people were still not willing to go for testing.

Besides, he said, it took quite a while before people moved from HIV infection to AIDS stages and within this period people could be going for treatment for opportunistic diseases. One can never tell though if the scaling up of testing would not create real problems, especially for most African countries hardest hit by the crisis.

Even for countries such as Ghana with a comparatively low HIV prevalence rate, there may be more people out there who are infected with the epidemic and only an increase in the number of people getting tested would reveal the level of preparedness to deal with a likely upsurge of cases of infected persons who need help.

hat is certain now is that there are calls for an expanded HIV testing and with the scaling up of HIV testing and counselling in African countries, a lot of preparations would be needed including strengthening of capacities to avoid disruptive shortage of test kits while ensuring adequate pre-testing and post-testing counselling, referral services and a legal and policy environment to cope with abuses of the rights of PLWHA.

No doubt the goal of reducing the spread of HIV infection has become very critical and an expanded HIV testing is important to reaching this goal.

Source: Accra Daily Mail

Mums-to-be shun Malawi HIV tests

2005-05-18T15:52:00.000+07:00

BBC News, Thyolo, Southern Malawi

Malawian health officials are deeply concerned at the reluctance of pregnant women to go for HIV tests, even though those who test positive are given anti-AIDS drugs.

"Most of the women that have come to be tested have been either attacked or left by their husbands," said Edwin Bakali, District Health Officer for Thyolo, which has one of the highest figures for HIV infection in Malawi, one of the world's worst-hit countries.

Although some 14% of adult Malawians are HIV positive, the virus retains a strong social stigma and those who are known to be positive often complain that they are shunned.

As a result, many people prefer not to go for testing.

In Thyolo, pregnant women who have HIV are given Nevirapine, a drug that helps to prevent the mother from passing down the virus to the unborn baby, but many men still do not want their wives to be tested.

"The men are standing in our way to prevent the unborn babies from the pandemic," Mr Bakali said.

Some pregnant women have resorted to undergoing HIV/AIDS tests without the knowledge of their husbands.

A woman who did not want to be identified said she had come for a test without the knowledge of the husband fearing she would be divorced if found positive.

"I couldn't tell him because he would have beaten me or even left me," she said.

Not all husbands though are against the idea of their pregnant wives undergoing an HIV test.

Jacob Kafulafula is one of the men who believe unborn babies should be protected from HIV/AIDS.

"I am ready to support my pregnant wife if she wants to know her status, it helps a lot," he said.

Mr Kafulafula said that men who stop their wives from taking HIV tests are ignorant.

"These women have got rights, so have the unborn babies," he said.

Although the tests are confidential, some fear that their status might be revealed when statistics are published on the prevalence of HIV in Malawi.

Thyolo hospital is just one of the country's many hospitals distributing Nevirapine facing similar challenges.

At Mlambe Mission Hospital in the commercial capital, Blantyre, pregnant women are also shying away from HIV testing because they fear for their marriages should they test positive.

Dr Phylos Bonongwe of the hospital bemoaned the low turnout of pregnant women who are expected to go for voluntary counselling and testing, VCT, before Nevirapine prescriptions.

Mr Bonongwe says the hospital launched a prevention of mother-to-child transmission programme in January to distribute Nevirapine to HIV-positive pregnant women.

He, however, says only six women have turned up for the tests so far.

Dr Bonongwe says this is threatening the hospital's efforts to combat the HIV/Aids pandemic.

Those women who have refused an HIV test during antenatal clinics are given a second chance just before delivery but few take up the offer.

Olivia Mangulenje, a senior community health nurse in Thyolo, says the only solution is a public information campaign, which has already started, aimed at both men and women.

"But before convincing the women, we must find out why are the men refusing - if it is a question of fear or just traditional beliefs," she said.

By Aubrey Sumbuleta
Story from BBC NEWS: source file here

Published: 2005/05/17

HIV Testing Should Be Offered to All Who Are Sexually Active, Researchers Say

2005-04-14T11:41:00.000+07:00

HIV Testing Should Be Offered to All Who Are Sexually Active, Researchers Say
Clin Infect Dis 2005;40:1037-1040.
*****

New York (Reuters Health) Mar 31 2005

Now is the time to implement routine, not risk-based, HIV testing, according to a viewpoint published in the April 1st issue of Clinical Infectious Diseases.

"Establishment of routine testing for HIV infection is essential to reduce the number of persons living in the United States who are infected with HIV but are unaware of their HIV serostatus," state Dr. Curt G. Beckwith from Brown Medical School in Providence, Rhode Island, and colleagues from Emory University School of Medicine in Atlanta, Georgia, and Johns Hopkins School of Medicine in Baltimore, Maryland.

The authors explain that significant numbers of persons with newly diagnosed HIV infection present late in the course of the disease, not only worsening their prognosis but also increasing the likelihood of their transmitting HIV to others.

Moreover, the researchers write, current prevalence-based recommendations for testing are impractical, because few physicians working in the community can really know whether they are working in a high-prevalence area or not.

Also, assessing patients' risk for infection is plagued by inaccurate information received from patients, the commentary suggests.

Even without these factors, health care providers may avoid offering HIV testing for a variety of reasons, ranging from informed consent to counseling issues to time constraints.

The essay proposes "a new policy whereby health care providers routinely offer HIV testing, irrespective of perceived risk." To make this workable, the authors say, counseling needs to be streamlined and rapid HIV testing implemented in the appropriate setting.

"Early diagnosis provides an opportunity for linkage to care, with the goal of preventing opportunistic infections and the development of severe immunosuppression," the researchers point out. "Early diagnosis also allows for risk-reduction counseling, which can reduce transmission of the HIV virus."

HIV testing "should be performed routinely for all sexually active persons, to diagnose HIV infection and to prevent AIDS," they conclude.

Testing key to curbing AIDS pandemic - Holbrooke

2005-03-22T01:11:00.000+07:00

(18 March 2005)

BEIJING - Better testing is the key to fighting the global AIDS pandemic, Richard Holbrooke said on Friday in Beijing, where he was in town to encourage Chinese businesses to play a role in stopping the spread of the disease.

The former ambassador to the United Nations who now heads the Global Business Coalition on HIV/AIDS also had harsh words for the World Health Organisation, saying its emphasis on providing anti-retrovirals was misplaced when most of those with the disease did not know they were infected.

"The failure to test is the weakest link in the policy. If testing is not encouraged, AIDS will become, worldwide, the ultimate weapon of mass destruction," he told a news conference.

Holbrooke praised China's efforts to fight AIDS, saying the SARS outbreak in 2003 had been critical to changing central government's attitudes toward the disease by highlighting the economic consequences of allowing its spread.

He had harsher words for the WHO's "3 by 5" initiative to provide anti-retroviral therapy to 3 million people with HIV/AIDS by 2005, saying it was an advertising slogan that could not be fulfilled and that just 800,000 had been reached to date.

"Even if they did get to 3 by 5, they wouldn't catch up with the spread. The only way to get there is with testing," he said.

POLITICAL SENSITIVITY

WHO officials in Beijing were not immediately available for comment.

But Holbrooke's emphasis on testing highlights the problems remaining in China, where, despite high-level shows of support, prevention is still hampered by social stigma and political sensitivity.

Holbrooke said testing should be carried out routinely for patients undergoing operations, couples getting married and for pregnant women, but he acknowledged compliance with such a policy would be difficult without guarantees of confidentiality.

That presents a challenge for China, where the government was slow to acknowledge the epidemic and says it has fewer than 1 million cases -- a figure many AIDS organisations say is a gross underestimate.

At the highest levels, the government's attitude has changed.

"The government will further enhance legislation on prevention and treatment and invest additional resources in this work," Health Minister and Vice-Premier Wu Yi said.

"I hope Chinese businesses will take advantage of the growth of their companies to ... take steps to harness and develop workers' enthusiasm for this cause," she told Friday's forum, aimed at harnessing business resources and skills to fight AIDS.

Her comments followed the lead of President Hu Jintao and Premier Wen Jiabao, who have both visited hospitals to shake hands and chat with AIDS patients.

But China has also been criticised for not holding any local officials accountable for a blood-selling scandal involving state-run health clinics, and journalists who travel to the countryside to report on the disease are routinely detained.

"China is at a crossroads in the fight against AIDS," Holbrooke said. "They're either going to stop it and strangle it, or it's going to spread."

By Lindsay Beck (Reuters)

Source

From VCT to ‘routine testing’?

2005-03-14T19:26:00.000+07:00

Why we should oppose a return by stealth to the days of mandatory HIV testing

It is time to raise the alarm about HIV testing. In addition to fighting HIV and AIDS, we now must return to an issue that many of us thought had been settled years ago: voluntary versus mandatory testing.

No-one who believes in enhancing treatment access can question the need to scale up HIV testing. The expression “routine testing” has been often used at the XV International AIDS Conference to describe this. On the surface, it may seem perfectly reasonable to choose the word “routine” to describe a procedure that is to be done systematically in a health setting.

However, given the past history of the responses to HIV/AIDS, there is an ominous subtext taking form. Early in the AIDS epidemic, members of affected communities and human rights activists argued that the HIV test must be voluntarily, because consent was central to encouraging testing and creating a climate of confidence and mutual trust between the person tested and service providers. Most public health professionals eventually recognized this.

The mounting pressure towards making HIV testing mandatory was curbed at that time. HIV testing with pre- and post-test counselling, often referred to as VCT (voluntary testing and counselling), became a central part of the global response to HIV/AIDS.

The experience of the last 20 years has clearly established that VCT remains the approach of choice to enhancing HIV/AIDS prevention, care and treatment, and today no one would dare claim mandatory testing in the health-care setting is an acceptable option. But with increasing frequency in recent months other terms have begun to creep into the dialogue gradually overshadowing VCT – most notably “routine testing.”

Why does this matter? Because the vagueness of this term hides the underlying intent and a range of practices, some of which with greatly damaging potential.

Much of the momentum behind the shift in terminology can be attributed to the urgency of scaling up access to antiretroviral (ARV) treatment throughout the world in particular where coverage of VCT remains low. Since many of the people who could benefit from ARVs do not currently know their HIV status, an enormous testing campaign must accompany any scale-up efforts. However, the rhetoric of “routine testing,” obscures a central issue – whether HIV tests are being routinely offered or routinely imposed, and whether in either case the individual has a true informed choice to opt in or opt out of being tested.

“Opt in” testing commonly refers to a situation in which patients are offered an HIV test by the service provider and make an informed decision to be tested. “Opt out” testing refers to a situation in which patients are systematically given an HIV test unless they take the initiative to decline.

If the world of HIV is to move forward we cannot afford vagueness in such critical concepts surrounding the key entry point to ART scaling-up. While every effort should be made to increase the practicality of VCT, the principle of voluntariness remains central to sound public health practice.

HDN Key Correspondent
Email: correspondents@hdnet.org

(July 2004)