Africa & Aboriginal Tuesdays: A National HIV Testing Day? by Eunice Menka

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 also 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 to policymakers and some health experts, an expanded HIV testing and counselling is increasingly becoming "an urgent policy imperative for HIV/AIDS control in many developing countries." International agencies such as the World Health Organisation 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 an expanded testing and counselling services, strengthening health systems, making available antiretorviral drugs (ART) in large quantities and developing a legal and policy framework to deal with stigma among other critical issue.

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, the 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 organisation 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 front-runners, 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 Centers 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 visit 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 has no specific day set aside as a national HIV testing day, the whole of November, yearly, has been set aside for free testing throughout the country with the regions given resources to go ahead with the programme.

"Currently there are 96 voluntary, counselling and testing sites throughout the country," he added. Policy makers have, however, said it has 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 Center 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 added.

Would African Ghana and other African countries have adequate supplies of ART for those who would test positive? Prof. Sakyi Amoa said 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 may 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 our level of preparedness to deal with a likely upsurge of cases of infected persons who need help.

What 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.

This article was published on Ghana Web

Eunice Menka

Tuesday, September 27, 2005