The 2011 Uganda AIDS Indicator Survey shows that although 90% of Ugandan adults aged 15-19 years know where to get an HIV test, only 57% have been tested and received the results. And of those that tested HIV positive, only 40% knew they were HIV positive. This means that millions of Ugandans are living with HIV but they do not know. This is a very unfortunate situation given that HIV Counseling and Testing (HCT) is the only way through which the infected people will be identified and then put on treatment.
Several studies, including one done in Rakai district, Uganda, show that when people living with HIV are put on treatment, it reduces the number of viruses circulating in their blood. As this happens, the ability of the person living with HIV to spread HIV to another person reduces substantially. In addition, another study done on couples where one was HIV positive and the other HIV negative also in Rakai district in February 2011 showed that HIV transmission was reduced significantly after the HIV positive partner started treatment. This means that, if we can manage to identify people living with HIV through early testing and put them on ARVs, they would not spread the virus.
Thus, after years of mainly using Voluntary Counseling and Testing (VCT), where HIV testing is provided to individuals who seek the service out of their own free will, efforts are now urgently needed to increase the provision of HIV testing through a wider range of options within the reach of every Ugandan. Such options would include routine testing and counseling, mobile counseling and testing plus home-based counseling and testing, followed by immediate linkage to treatment.
Routine testing and counseling is where by individuals who go to a health centre are offered HIV testing as part and parcel of other services they may require, irrespective of the presenting illness that has brought them to the health centre. The principle of the mobile counseling and testing approach is to take the service to populations that are considered to be 'hard-to-reach', such as internally displaced populations, sex workers, long distance drivers and employees at their workplaces while the home-based approach is whereby HIV counselors offer HIV counseling and testing services in clients' homes.
The biggest advantage with the above approaches is that they complement each other; while the routine one targets individuals visiting health facilities, the mobile one caters for those not coming to the health facilities and the home-based one caters for all the rest. The last two approaches also have the advantage of eliminating the cost of transport to the test site as well as increasing uptake especially among women, as they do not need to seek permission or money for transport from their male partners. These approaches can also reduce stigma associated with being seen at the clinic.
Needless to say, early access to treatment is an extremely promising tool in our fight to get to zero new HIV infections but it requires that millions of people with HIV get to know their status early. This can only happen where capacity and HIV/AIDS related services are availed with immediate high quality linkage to care and support. So as Ugandans, if we embrace wide-spread and regular testing and counselling using the three approaches above, immediate linkage to care and immediate treatment, we can have an HIV/AIDS-free generation in a decade!
The writer is a Makerere University School of Public Health-CDC Fellow