Published in The Hindu on July 4, 2007
The new guidelines issued recently by the World Health Organisation to expand access to HIV testing mark a paradigm shift in the approach to testing people for the viral infection. By making HIV testing available at health facilities, and not just in certain designated centres, based on the epidemic status of individual countries, the world body intends to change the current client-initiated procedure to a provider-initiated HIV testing and counselling strategy. Unlike the client-initiated approach where individuals take the initiative to get themselves tested, the provider-initiated strategy shifts the onus of detecting HIV infection to the health care provider. There has been a compelling need for 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 infection status. This ignorance has not done any good 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 benefits 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, has clearly underlined the need for consent for testing by individuals. Making testing and counselling widely available 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 in reducing the number of vertical transmissions from mother to child is a testimony to the effectiveness of a provider-initiated HIV testing policy. The success of a country’s expanded access to testing will hinge on easy and assured access to medicines. It must be borne in mind that easy availability of medicines has been instrumental in transforming HIV from a virtual death sentence to a chronic condition. While generic versions of first-line medicines are available cheaper in India and in many 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 on-going tussle in Thailand between the government and the U.S. based pharmaceutical company to make available cheaper second-line drugs has been drawing international attention. How this knotty issue gets resolved will ultimately determine the long-term success of increasing access to testing and providing affordable treatment, especially in the developing countries that have a huge disease burden.