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"Blazing a trail for Africa"
The
Star (www.thestar.com.my)
(13/08/06)
IF the World Health Organization does decide to introduce widespread routine
HIV testing, especially in “high-burden” parts of Africa where more than 30%
of the population is infected, then Botswana is providing a useful test run.
Botswana, where one in three people has HIV, introduced universal access to
antiretroviral therapy (ART) in 2002, and routine voluntary HIV testing in
early 2004. But while a US analysis of Botswanans’ attitudes to routine
testing has produced some grounds for optimism, it has also raised some
concerns.
Led by Sheri Weiser, of the University of California, San Francisco, the
study of 1,268 adults found that 68% of those questioned felt they couldn’t
refuse to have the test. “Some people may feel an element of coercion,” says
Weiser. “So informed consent needs to be protected as these new testing
policies are rolled out.”
Meanwhile, almost half the respondents hadn’t heard of the routine testing
programme, and 43% thought that fear of the test would discourage people
from visiting their doctor.
Overall, though, there was widespread support for the policy. Four-fifths of
respondents were “extremely” or “very much” in favour, and 93% thought it
would meet the WHO’s objective of increasing access to ARTs. Sixty percent
thought that it would destigmatise HIV infection.
However, that success might not translate to other African countries, where
access to ART is not readily available. “The biggest inducement to test is
the availability of effective treatments,” says Lisa Power, policy director
at UK-based AIDS charity the Terence Higgins Trust. “If you can’t treat it,
the stress level of knowing you’ve got the virus is intolerable. I think the
WHO would have an uphill struggle to push it in countries where there are no
treatments available.”
In developing countries, the rationale behind routine testing is similar to
that being pushed in the US. “We’re trying to avoid people being diagnosed
too late,” says Lori Heiber-Girardet, a technical officer with the WHO’s
HIV/AIDS programme. She says the tests would only be offered in clinical
settings such as health centres and hospitals, where many patients are
likely to have the virus anyway.
In high-burden countries, an estimated 90% of people are unaware of their
HIV status. Even if they were diagnosed, often there simply wouldn’t be the
drugs available to treat them. Yet there are benefits to testing even in
countries where ARTs are in short supply, says Heiber-Girardet.
“You can still be offered measures that prevent progression, such as
prophylaxis for opportunistic infections, better nutrition, information on
having safe sex, and access to support groups.”
Nonetheless, the WHO is expected to accompany its recommendations on testing
with a plan for increasing access to treatment. That includes addressing not
only issues of drug supply, but also the problem of personnel, says
Heiber-Girardet.
“The problem is a lack of healthcare professionals,” she says. “HIV is
treated as very specialised disease but there’s no reason for that. We don’t
need doctors and nurses to do the testing. We can have lay volunteers do
it.”
By training nurses’ assistants and volunteers to do most of the work, much
of the burden associated with increased testing will be shifted off the
doctors, Heiber-Girardet says, enabling them to devote their time to those
who are severely ill. She stresses that routine testing would also be
accompanied by a programme of counselling for those diagnosed with the
disease. – Premium Health News Service/TMSI
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