WHO/UNAIDS prescribes Care Provider Initated HIV testing for all

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[WHO (2007) GUIDANCE ON PROVIDER-INITIATED HIV TESTING AND COUNSELLING IN HEALTH

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WHO prescribes HIV testing for all

2 Jun, 2007 l 0307 hrs IST l Malathy Iyer/TIMES NEWS NETWORK

MUMBAI: The World Health Organisation (WHO) has rolled out a new

recipe to fight the HIV\AIDS epidemic: doctors should urge all their

patients to undergo the HIV test rather than recommending it only to

a few. Of course, people who don't want to undergo the test can

choose to opt out.

On Wednesday, the WHO unveiled its latest recommendation- a far cry

from its older module of seeking voluntary testing for HIV\AIDS-

ostensibly to identify the 'silent epidemic'. Persons who don't know

they are infected (and WHO believes there are millions who don't)

will thus know their status, take steps to not infect others and seek

timely help, goes the new WHO logic.

In New Delhi, NACO (National AIDS Control Organisation) secretary K

Sujatha Rao welcomed the new guidelines. " We are positive about it.

What is wrong with doctors advising patients to test for HIV? " she

asked. " We can't stretch the confidentiality clause to the point that

it affects the patient's health. " Indian patients reach hospitals too

late for any help to be provided. " Such a recommendation would only

help us treat patients, " she added.

While NACO now brainstorms on how to roll out the new recommendations

and tackle the ethical issues, many public health experts in India

are not sure about the mandate. " We have to use such guidelines

intelligently, " says Dr R D Lele, who is credited with identifying

and treating the first HIV-positive patient of India over 20 years

ago. " We only have to target sexually-active persons in the age group

of 16 to 45 years, drug users and patients who have undergone blood

transfusions, " he says. " What is the point of asking a 65-year-old

patient with cough and cold to undergo the test? "

Moreover, as Dr Lele points out, if the test is offered routinely to

all patients, there is a danger of false positives. " The HIV test is

known to give false positive in case of patients suffering from

malaria or chronic liver disease. "

In India, there also is the problem of stigma attached to the HIV

diagnosis. In Africa, the attitude is different considering that the

epidemic has wiped out tens of thousands in their productive age

group. In the US, the government is trying to implement the Centers

for Diseases Control recommendation for annual testing for people in

the age group of 16-35 years.

But in Kolkata, the staff of the Calcutta Medical College Hospital

refused to touch the body of a young AIDS patient who died there two

days ago. The extent of stigma attached to the HIV\AIDS tag is still

immense. " A couple of months back, a pregnant woman died outside a

government hospital in Indore. In Lucknow, a renal failure patient

who was HIV-positive had to wait for 16 hours before activists could

get him a hospital bed, " pointed out HIV rights activist-writer Bobby

Ramakant from Lucknow.

Experts recommend that India should first put in place the many

checks advised in the WHO guidelines: counselling before and after

the HIV tests, introduce universal precautions such as double gloves

for doctors and medical staff treating HIV\AIDS patients, etc. " We

first have to work towards reducing the stigma towards HIV\AIDS in

healthcare settings, " says Ramakant.

Akila Shivdas from the Centre for Advocacy & Research (CFAR), which

has been working in the field of HIV\AIDS advocacy, felt WHO's new

recommendations are a sureshot prescription at normalising the

epidemic. " The WHO idea is that by not according HIV\AIDS a special

category, the epidemic can be normalised. But this normalisation

process can't begin from the top, it has to start from within the

community, " she advised.

She points out to Thursday's news about the emergence of new HIV\AIDS

hotspots in Uttar Pradesh and Bihar. " We now have small towns and

villages with 1% incidence of HIV in pregnant women. This is

considered high. If the testing is made mandatory in such areas

without the proper buildup, it can have a disastrous effect. "

The WHO team agrees that the shift from voluntary testing to provider-

driven testing is drastic. " This is radical in the sense that things

have to change, " said WHO HIV/AIDS director De Cock. " Across

the world, people with HIV are flowing through healthcare settings,

not being diagnosed and not being offered the advantages of knowing

their status. "

But it remains to be seen if the formula will work in India, in the

manner it is meant to.

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