Comments on CDC's new HIV prevention initiative

[Guest guest]

Dear friends,

The CDC announced a new HIV prevention initiative that focuses on the use of

rapid HIV testing as a routine component of medical care. The new strategy

applies common public health principles, including broad and routine screening,

to the problem of HIV transmission. CDC's former guidelines required extensive

behavioral counseling and other special measures, which many now view as

barriers to prevention on a national scale. The new initiative, called

" Advancing HIV Prevention: New Strategies for a Changing Epidemic, " is outlined

in the April 18 issue of Morbidity and Mortality Weekly Report.

CDC will promote recommendations for routine HIV testing of all pregnant women,

and, as a safety net, for the routine screening of any infant whose mother was

not screened.

The details are available at

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5215a1.htm

I would like to know the opinions of our group on this.

1. Should this change in strategy , affect our testing strategies too?

(especially when most of our testing centers are not offering a pre test

counseling)

2.Should we start testing all pregnant women and children?

Remember we don’t have any treatment (or we don’t want to provide) to offer once

somebody tested positive. At the same time most of the persons who learn that

they are HIV infected adopt behaviors that might reduce the risk for

transmitting HIV even in India.

Ajith

E-mail: trc_ajisudha@...

[Guest guest]

Dear Forum members,

This is in response to CDC's new preventive inititiative .

It is appreciable, when there is strategy changes based on the change in

epidemiological trends. As we learn from the article came in MMWR, it seems

that there is need for routine screening for HIV. One positive aspect all

of us felt in the HIV prevention programmes was its sensitivity towards the

vulnerable groups. Routine screening was not done because of the cost and

feasibility of testing, lack of treatment and for fear of discrimination of

the vulnerable groups like MSMs.

Now if all these factors have changed, we can think of routine screening. CDC

has changed it based on the change in epidemiological trends, and the

availability of rapid tests. Treatment is offered and collaboration with CBOs

(assume that organization of MSMs)is repeatedly mentioned. We may not be able

to comment on this, because of the lack of knowledge about the situation in that

particular community.

We are apprehensive about a few things in adopting this in our country.

When institutions like CDC changes strategies, there is the possibility of

adopting it by other countries following guidelines given by donor

agencies. Though there may be mentioning of situation analysis, culture

specificity, contextualising etc, when it is translated to programmes and

action all these will be diluted. This happens because of the lack of

bargaining power with the donor agencies in the case of less developed

countries, in built corruption in the systems of these countries and lack

of political will to address the rights issues of the marginalized and to

decentralize power.

If we just adopt this, can we provide treatment (ART) for those who are detected

early? Or it will be implemented in a haphazard way and only help the drug

manufacturing companies? How do we address the issue of stigma and

discrimination, especially if the screening is done among high risk groups?

When ante natal screening is done, are we aiming at prevention to new born only

or treatment of mothers too? If mothers are not treated, do not we have to

consider the ethical implications? Regarding participation of CBOs, there should

be real participation in the decision making process which is possible only if

their rights are accepted.

In countries like India, addressing the rights issue of the vulnerable in the

wider level is very important in prevention strategies. Now at least

chartering of legislation for the positives is initiated by NACO. The

strategy development for HIV prevention should be based on the legal and

social status of the vulnerable and with the participation of the concerned

groups.

Community participation does not mean just putting one or two members in the

committee. Sometimes, those who are selected as representatives of the CBOs get

absorbed into the systems ideology, since their status is changed suddenly and

they get isolated from the community following their status change. They may

become unable to represent the interest of the community.

To prevent this, space should be provided to have rigorous interaction among the

people in the community themselves and varied positions should be represented

before coming to conclusions. This is possible, only if there is a conducive

environment created by the political movement of these groups.

I am not against screening. But it can be done in a meaningful way, only

if it is sensitive to the contextual issues. In the article it is placed in

a right frame i.e. any one should not be denied of opportunity to get

tested and treated. It implies that the need to get tested comes from the

community itself. Hope that it is not rhetoric.

Dr. A. K. Jayasree

E-mail: maitreya@...