With the World Health Organisation releasing guidelines on HIV self-testing, a major obstacle in improving access to diagnosis has been cleared. Though much progress has been achieved in India in making HIV testing accessible and free of cost, many infected persons remain unaware of their status. Across the world, nearly 40 per cent of people with HIV are unaware of their infection and run the risk of unknowingly transmitting it. Besides going a long way in preventing new infections, early diagnosis will help in a prompt start to treatment and enable the infected to live longer and healthier. Though there has been a 66 per cent drop in incidence in 2015 in India compared with 2000, the number of new HIV infections last year was 86,000; children below 15 years of age alone account for 12 per cent of this number. In 2015, the total number of people with HIV in India was estimated to be 2.1 million. Of this, 1.5 million were detected and tested at integrated counselling and testing centres (ICTC) and about a million people are on treatment. This leaves about half a million who are unaware of their HIV status. The government has approved in principle the proposal to take HIV testing closer to those in need by starting community-based testing. This will soon become operational and will be in addition to institutional testing. India is also weighing the option of self-testing.
The WHO-approved OraQuick HIV self-testing is based on HIV antibodies present in oral and blood samples. The test can detect antibodies developed within three months of getting infected. It is a screening test, and a positive result should be reconfirmed though a blood-based test. Despite greater awareness, people with HIV still face stigma and discrimination. As a result, getting everyone at risk of HIV infection tested has been a challenge. The OraQuick self-testing makes diagnosis easier and faster, besides ensuring privacy and confidentiality, thus encouraging more people to get tested. But there are challenges in terms of counselling and sensitivity, with the accuracy of the tests pegged at around 93 per cent. Counselling has to be done through innovative ways, such as over the telephone, as in the case of the U.S. Unlike the conventional method of getting tested at ICTCs, people self-testing should be more aware about the possibility of false negatives. But the risk of not getting tested far outweighs the limitations posed by self-testing. Twenty-three countries have in place policies that support HIV self-testing. It is time India adopted it quickly to enable more people to test themselves and help break the transmission cycle.