SOURCE: AF-AIDS is the regional forum on HIV/AIDS in Africa, coordinated by the Health & Development Networks Moderation Team (HDN, www.hdnet.org) with technical support from Health Systems Trust (HST) on behalf of the AF-AIDS Steering Committee (HST, HDN & SAfAIDS), with the support of the Government of Ireland. Reproduction welcomed provided source is cited as follows: AF-AIDS eForum 2003: af-aids@healthdev.net Issues and debates in HIV testing: To reach 3 by 5! By HDN Key Correspondent 13th ICASA, Nairobi, Kenya, 25 September 2003 ************************* Will it be possible to meet the WHO goal of 3 million people having access to antiretrovirals by 2005? Speaking at a Tuesday Roundtable discussion on 'Issues and debates in HIV testing', Dr Catherine Sozi of UNAIDS said that 30 million HIV positive people would have to be identified and 300 million people tested at a cost of US$1. 8 billion - no mean task! "Currently less than 10% of the adult African population know their status," Dr Mbori Ngacha had reported during the morning plenary. Clearly, the uptake of voluntary counselling and testing (VCT) had been limited to date. Fear of knowing one's status has been cited as the greatest barrier because of stigma and seeing HIV/AIDS as a death sentence. VCT offers people the opportunity to 'take control of their lives' and to either maintain their negative status or to live positively. It is an effective prevention strategy and the the entry point to care and support and possible access to ARVs. Relevant services such as treatment of sexually transmitted infections (STIs) and opportunistic infections (OIs), PMTCT (prevention of mother-to-child transmission), nutritional and psychosocial support can also be accessed. However, given the low testing uptakes, will VCT ever be feasible or reach targeted populations? Opinions differ. "All clients should be tested, counsel if you have time", said Dr Festus Ilako at the Roundtable. "Diagnostic and routine testing gives the clinician the opportunity to plan effective management of patients." Dr Sozi expressed concern about testing that is neither voluntary nor involves adequate counselling as a breach of a persons rights to privacy. Guiding principles should be adhered to which include informed consent, provision of post-test counselling and confidentiality. 'Not all testing is VCT', said Dr Ngacha. Routine testing is recommended in antenatal care, mandatory testing is required in specific instances, e.g. blood donations and diagnostic testing is appropriate in certain settings. Counselling still remains an integral part of the strategy and should be provided along the continuum of care at all levels of health provision. Ongoing counselling is essential, especially to HIV positive clients and those receiving ARVs. Scaling up counselling and testing services requires political commitment, adequate resource mobilisation as well as training and mentoring of counsellors. Ongoing debates regarding who should do the test, which tests should be used and quality assurance practices require clarification. Presentations made by various countries during this conference indicate that similar challenges exist and that further guidance and support is needed if these goals are to be reached. Strengthening of relationships with partners in the realm of the NGO, CBO and private sector are recommended. The government sector is unable to meet the challenge alone. Finally, perhaps the greatest challenge of all, is to mobilise communities to see that "the HIV test is not the enemy" as suggested by Dr Ngacha, and thus turn the tide on the pandemic. I KNOW MY HIV STATUS, DO YOU? ICASA delegates are practising what they preach. Approximately 70 delegates have been counselled and tested for HIV thus far! "Do you have the power? Get Voluntary Counselling and Testing! Get knowledge! Get power!" These words challenge delegates as they visit the African Medical Research Council (AMREF) Stand 218. Mathew Ngunga, the AMREF Project Co-ordinator, smiled that the response had been overwhelming. Fourteen dedicated counsellors test and counsel clients from 8: 30am- 5pm daily. Clients are seen hourly according to their booking system. A 10% target of the delegates was the initial aim, but with approximately 7000 delegates at the conference and limited counselling space, reaching this target is unlikely. AMREF partnered with NASCOP (National AIDS STI Control programme) on this project and hope to document the findings. "I'm pleased that people are taking testing so seriously. This will reduce stigma. It also is interesting that an equal percentage of men and women have come for testing", said counsellor Florence Githuthu. "We refer clients are referred to relevant support services". Florence appealed to delegates, 'It is challenging to know ones status. Take the test - take control; it is well worth it!' **************** HDN Key Correspondent Team To contact the HDN KC team during ICASA or to comment on the Conference coverage: info@hdnet.org = = = = = = = = = = = = = = = = AF-AIDS is supporting the 13th ICASA in Nairobi, Kenya (Sept 21-26 2003) http://www.icasanairobi2003.org/ = = = = = = = = = = = = = = = =