WHO and UNAIDS Set Controversial Course for HIV Testing
By Emily Bass
The Lancet
December 12, 2006
The World Health Organization and UNAIDS are drafting HIV testing recommendations, set for release early 2007, that will endorse provider-initiated testing and counseling (PITC). The recommendation aims to reach the nine in 10 HIV-infected people worldwide who are undiagnosed and thus miss out on treatment services when they are available. The more infected people who know their status, the more meaningful HIV treatment access would be.
In September, CDC recommended routine, voluntary HIV screening for people ages 13-64 in health settings in order to link those infected to earlier care and treatment.
The WHO/UNAIDS draft guidelines emphasize informed consent for testing, but human rights advocates worry whether that will translate to the diverse international field. "This has to live in the reality of very, very fragile, under-resourced health-care settings," said Mandeep Dhaliwal of the International HIV/AIDS Alliance. There can be adverse consequences to being identified as HIV-positive, including stigma, said Alan Berkman, a Columbia University AIDS expert.
In Botswana, Malawi, and Uganda, the PITC approach has increased the acceptance of testing, though data on treatment, care, and stigma are lacking.
"The most important right that we have is to protect is the right to live," said Jim Kim, head of Harvard's Center for Public Health and Human Rights and a "Know Your Status" campaigner for Lesotho.
In Uganda's two largest teaching hospitals, PITC has begun to ease testing-related fears, said Rhoda Wayenze, Uganda's PITC program head. While Uganda's program has support from the US President's Emergency Plan for AIDS Relief, other countries implementing PITC could face the same consequences: identifying more patients than can be treated. Uganda has scrambled to create more treatment clinics.
"If you argue this is not the right thing to be doing, I would say to you, 'Okay, you must take ownership of the downside of not offering testing: unknown disease, pediatric death, preventable death. It's all measurable,'" said Kevin De Cock, WHO's HIV/AIDS director.
