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Expanding access to HIV testing

The new guidelines issued recently by the World Health Organisation to expand access to HIV testing mark a paradigm shift in the approach to detection of the viral infection. The emphasis will now be on making the facility available at all the health centres, not just in certain designated ones, based on the epidemic status of individual countries. The initiative for testing, which has remained with the individual concerned, will henceforth come from the health-care provid er. There has been a compelling need for such a change in approach to tackle the infection, as nearly 80 per cent of people living in low and middle income countries are unaware of their status vis-a-vis HIV infection. This ignorance has been a major handicap in containing the spread of HIV. Early detection plays a crucial role in increasing longevity and reducing the rate of HIV transmission. Certain countries in Africa have already realised the importance of early detection and have accordingly adopted the provider-initiated testing and counselling approach.

Given the twin problems of stigma and discrimination prevalent in many countries, the WHO guidelines, much like the recommendations of the Atlanta-based Centres for Disease Control and Prevention, have clearly underlined the need for securing the consent of the individual for undergoing the test. The availability of testing and counselling at all health centres is likely to make more people come forward and get tested. The willingness of a large number of pregnant women to get themselves tested at pre-natal clinics and its ripple effect by way of reducing the number of mother-to-child transmissions are a testimony to the effectiveness of a provider-initiated HIV testing policy. It must be borne in mind that easy availability of medicines has been instrumental in transforming the outlook on HIV from that of a virtual death sentence to one of a chronic condition. While generic versions of first-line medicines are available at affordable prices in India and many other developing countries, second-line drugs remain very expensive. The need for second-generation drugs will become real when resistance to first-generation drugs sets in. The ongoing tussle in Thailand between the government and a U.S.-based pharmaceutical company over making available cheaper second-line drugs has drawn international attention. How this knotty issue gets resolved will ultimately determine the success, in the longer term, of initiatives to provide wider access to testing facility and affordable treatment, especially in the developing countries that have a huge disease burden.

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