Could HIV self-testing be a game changer in Africa?
LONDON (Thomson Reuters Foundation) - In Africa, where fewer than half the people know their HIV status, HIV self-testing is being explored as a way of encouraging more individuals, particularly in high risk groups, to know their status as a first step to seeking treatment, an AIDS charity said on Monday.
Despite decades of investment in testing and counselling for the human immunodeficiency virus (HIV) that causes AIDS, only about 15 percent of Zambians, 25 percent of South Africans and 39 percent of Swazis had been tested for HIV in 2011, U.N. figures show. In Botswana, the rate was higher with 62 percent of the population tested for HIV in 2011.
Experts say one of the main reasons people in sub-Saharan Africa used to give for not getting tested 10 or 15 years ago was the lack of treatment for HIV. But today, drugs that can control the virus for decades are increasingly available.
"Some people continue to live in denial. But we also know that some people don't know their status because of stigma and discrimination," said Felicitas Chiganze, chief operating officer of the Southern African AIDS Trust, which works on the response to HIV in six African countries.
The group published legal research on Monday comparing laws and outlining the human rights implications of HIV self-testing in 10 countries: Botswana, Malawi, Mozambique, Tanzania, Zambia and Zimbabwe where it works, and the United States, France, Britain and South Africa.
"We felt that if there was some initiative or some method that would enable people to know their status without going through some of the formal channels, that this could actually contribute to increasing the uptake for HIV testing," Chiganze told Thomson Reuters Foundation by telephone from Johannesburg.
She said sex workers and men who have sex with men are among the groups facing the heaviest burden of HIV, yet are some of the most hard to reach in terms of testing and treatment.
NO SILVER BULLET
The research was released ahead of July 20-25 international conference on AIDS in Melbourne, where one of the key themes will be how the world can step up the pace against HIV/AIDS.
The study shows that the United States is the only country which has an authorised HIV self-testing kit on the market, and that although HIV self-testing is legal in Britain, no kits have met minimum European standards for use in the UK.
The study also identified barriers to HIV self-testing in the African countries.
For example, in Tanzania and Botswana, HIV testing is restricted to government-approved testing centres and can only be done under the supervision of a trained professional. In South Africa, pharmacies are prohibited from selling HIV self-testing kits although self-testing is not outlawed there.
The World Heath Organization (WHO) says HIV self-testing was first considered more than 20 years ago, but has not been widely implemented.
"For many policymakers, HIVST (HIV self-testing) remains a contentious issue," WHO said in a report following its first international symposium on HIV self-testing in 2013.
Research commissioned by Chiganze's group also looked at a range of ethical concerns, including the possibility of individuals being forced to test themselves against their will.
"There's also the recognition that the testing kits are not necessarily conclusive," Chiganze said, adding that a positive result would require a further test by a doctor.
Chiganze said HIV self-testing was not a "silver bullet" and should not be seen in isolation to other ways of tackling HIV in sub-Saharan Africa where 23.5 million people were living with HIV in 2011, about 69 percent of the global total.
She says the research aims to spark a debate among government bodies with the hope that HIV self-testing pilot projects could be set up.
"We're aware that with UNAIDS proclaiming that they're working towards the goal of zero new HIV infections, zero discrimination and zero AIDS-related deaths, that this really wouldn't mean much within the African context unless there is an increase people's knowledge about their own status, " Chiganze said.
Author: Katie Nguyen