31 January, 2007February 2007
Opinion
Ignorance is not Bliss – Testing to Know your Status
In this article, some controversial issues of voluntary versus routine testing are discussed. Let us know your opinion; write to [email protected].
Of the one million Americans with HIV, some 250,000 do not know that they are infected. If they do not know, they will not seek treatment and they are more likely to infect others. The Centre for Disease Control (CDC) of the US Department of Health and Human Services therefore recommends that all Americans between the ages of 13 and 64 should be routinely tested for HIV.
The tests would not be compulsory but rather than testing only those who asked to be tested, the CDC wants clinics to test everyone who does not refuse to be tested, or the opt-out clause. In this way, HIV can be detected earlier, and the earlier it is detected the easier it can be treated.
Some 40% of Americans who are diagnosed HIV positive progress to full-blown AIDS within a year of that diagnosis, which suggests that they were infected without knowing it for as much as a decade.
The number of Americans with HIV increases every year. This is partly because drugs are keeping people alive longer. But the number of new infections has not fallen. It remained stable because people who are HIV positive do not know their status.
With routine testing, doctors also hope to reduce stigma which is one of the largest barriers for people to avoid testing. The head of the World Health Organisation’s (WHO) AIDS Department, Kevin de Kock, is quoted as saying that routine testing is a big step towards “normalising” HIV.
Will routine testing lead to mandatory testing? Doing away with written consent forms and pre-test counselling to simplify procedures as part of routine testing is certainly a dangerous development and poses threats to human rights.
Views have also begun to shift in Southern Africa. In 2004, Botswana became the first African country to introduce routine testing in its health sector, with Malawi and Lesotho following suit. Here the hope is also that by offering HIV testing as a routine part of any treatment, more people would be encouraged to know their status and that, over time, stigma will lessen.
Zambia has initiated routine testing at health facilities in a bid to eradicate the stigma associated with HIV/AIDS, by transforming it into an “ordinary disease”.
The Botswana authorities claim that very few people are opting out when confronted with the possibility to be tested and that a large majority of the population now know their status.
However, the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) has criticised the government for failing to launch a public information campaign, arguing that routine testing is only acceptable if patients know that they can refuse. Informed consent, counselling, confidentiality and access to treatment must be guaranteed.
The WHO currently holds consultations on provider-initiated testing. Testing for HIV serves as an entry point for both prevention and treatment. Taking an HIV test is arguably the most influential driver for behaviour change. If a person tests negative, the focus must be on education and support to ensure that the person takes responsibility to remain negative.
A person testing positive must be supported to take responsibility for managing HIV/AIDS as a chronic treatable disease, and to bring about changes in behaviour that will prevent further transmission. Antiretroviral treatment must be available.
The GBC/COSATU Guide quoted below sets out principles for counselling and testing at the workplace. Together with the unions, companies must take steps to:
• prevent any discriminatory practices against HIV status;
• ensure confidentiality and informed employee consent;
• ensure that there is no penalty if an employee chooses not to get tested;
• ensure that testing is not in the form of pre-employment screening or mandatory testing; and
• reduce stigma against people living with HIV in the workplace.
[Source: The Economist, 30 September 2006, from which the headline “Ignorance is not bliss” is also taken and various web postings of the UN Integrated Regional Information Networks.
A Practical Guide for Business Managers: Accelerating Access to HIV Counselling and Testing was published by the Global Business Coalition (GBC) Africa Office and the Confederation of South African Trade Unions (COSATU) in its 2nd print in August 2005.]
Facilitators’ Guide on Counselling and Testing
In December 2006, the International HIV/AIDS Alliance based in Brighton, UK, published a Facilitators’ Guide entitled “Let’s Talk about HIV Counselling and Testing.” The guide is a toolkit to build NGO/CBO capacity to mobilise communities for HIV counselling and testing. It makes specific reference to the significant policy changes that have occurred to models of HIV testing and the recent CDC recommendations (see article above).
The publication, which is available in English and Spanish, can be downloaded from the Alliance’s website www.aidsalliance.org. Established in 1993, the Alliance is a global partnership of nationally based organisations working to support community action on HIV/AIDS.
Russia – European AIDS Treatment Group Demands Action
With an estimated HIV prevalence of 1.1%, the Russian Federation is one of the European countries hardest hit by the HIV epidemic.
In a letter to the Russian Minister of Health Care and Social Development, the European AIDS Treatment Group deplores the serious shortcomings in standards of HIV care in the Russian Federation. Despite the fact that the alarming prevalence figures have been well known for years, the country has not scaled up treatment programmes to cover all in need of medication.
The European AIDS Treatment Group appeals to the Government of the Russian Federation and the Ministry of Health Care and Social Development to amend treatment guidelines. They must include, among other strengthening guidelines, the provision of antiretroviral drugs which conform to international standards; attention to the specific needs and requirements of injecting drug users, who represent 80% of all HIV cases in the country; and to adjust national healthcare budgets and the treatment programmes, under the Global Fund to Fight AIDS, Tuberculosis and Malaria, to treat all patients in need.
(Source: Break-the-Silence e-forum on HIV/AIDS, 3 January 2007. You can join by sending a blank message to [email protected])
Caribbean – AIDSs Crisis Blamed on Ignorance
Delegates at a Caribbean Summit on HIV/AIDS blamed widespread ignorance for the AIDS crisis in the region. Ignorance is undermining the efforts to fight the spread of the disease in the Caribbean, which has the second highest rate of infection after sub-Saharan Africa.
An estimated 500,000 people – or 2.4% - are HIV-positive. In 2005, an estimated 24,000 people died in the region from AIDS, making it the leading cause of death among people aged 15 to 44.
Discrimination by employers and others is so pervasive that people do not go for testing and infected persons often delay seeking treatment for the virus. A contributing factor is also that it is still largely perceived as a “gay disease.” Social stigma associated with the disease keeps many sufferers from receiving life-prolonging medicines.
(Source: Web posting on www.planetout.com, 22 January 2007)
India – Generic Drugs
India has become the premier drug provider for the developing world by producing cheaper generic versions of some of the world’s most effective medicines, including antiretroviral drugs. But the country’s decision to adhere to international patent regulations could limit access to generic drugs in the developing world. In future, when the country’s patent laws will hinder its pharmaceutical companies from producing the latest drugs as generic versions, prices will go up.
Some estimates indicate that Indian generic drug firms provide treatment for 50% of HIV-positive people in the developing world. The Indian generic drug company, Cipla, alone provides one in three HIV-positive people in Africa with antiretrovirals.
Pharmaceutical companies in India are, however, seeking to expand their market to wealthy nations – a move that could come at the expense of the world’s poor. In addition, the change in India’s patent laws has led many foreign drug firms to enter the market and target India’s growing middle class.
(Source: Web posting on www.medicalnewstoday.com, 10 January 2007, referring to a Christian Science Monitor article).
Global Fund Round 7
The Global Fund to Fight AIDS, Tuberculosis and Malaria will call for proposals for Round 7 on 1 March 2007. The deadline for submission of Round 7 proposals is set for 4 July 2007. Having learned from past experience, the Fund is encouraging early planning. A call for proposals for Round 8 will be issued on the same date in 2008.
ICEM Resource Guide on Website
In the January issue of the e-bulletin, we reported on the African Regional Workshop on fundraising and project writing. One of the tools used at the workshop was the ICEM Guide on HIV/AIDS Resources and Funding.
The Guide is now available on the ICEM website, in English and French. A Spanish translation is being prepared.
The Guide takes account of the fact that funding resources are decentralised and largely accessible at the national level. The introductory part refers to small-scale funding from national AIDS commissions and resources from employers, especially companies with which the ICEM has signed Global Agreements.
It gives fact-sheets on relevant intergovernmental organisations such as ILOAIDS, UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria, WHO, and the World Bank and lists a number of foundations and other organisations engaged in the fight against HIV/AIDS. An annex explains in more detail the Global Fund to Fight AIDS, Tuberculosis and Malaria, its structures and procedures.