15th Conference on Retroviruses and Opportunistic Infections Boston, Massachusetts - February 3-6, 2008

Conf Retrovir Opportunistic Infect 2008 Feb 3-6;15: (abstract no. 3)

Elizabeth Marum
Global AIDS Prgm, CDC, Atlanta, GA, US

BACKGROUND: Knowledge of HIV status is essential for access to care and treatment, yet most persons with HIV infection in Africa do not know they are infected. HIV testing provides an opportunity for intensive prevention services, though clear evidence is lacking for the effectiveness of HIV prevention counseling, particularly for those testing negative. Barriers to the expansion of testing include fear of stigma and discrimination, over-burdened health workers, outdated policies that limit the performance of HIV testing to laboratory technicians, and the lack of integration of testing into routine care. Inadequate access to primary health care and poor knowledge about the benefits of testing are additional problems.

METHODS: Efforts to address these barriers are at various stages in African countries. Public campaigns to promote HIV testing have been widely conducted. Legal protection for persons with HIV infection has been introduced in many countries, as well as efforts to reduce stigma surrounding AIDS. Policies are being modified to encourage “task shifting” from health workers to lay counselors, as well as policies allowing counselors to conduct simple, rapid tests in non-laboratory settings.

RESULTS: The dramatic increase in international funding for AIDS has significantly increased access to HIV testing, and more than 30 million persons have been tested in the last 3 years. Innovative approaches have been introduced, including door-to-door and mobile testing, home testing of family members of ART patients, and national campaigns or events. Services have been extended to high-risk groups, such as prisoners, the uniformed services, refugees, migrant and transport workers, and commercial sex workers.

CONCLUSIONS: In spite of these developments, many barriers remain. Integration of HIV testing into routine medical care in high-prevalence settings is undermined by the severe shortage of health workers, and separate testing services provided by a lay counselor may be the only practical approach in many countries. Partner disclosure remains difficult, and only a few programs have been successful in increasing couple counseling and testing. Continued international and national support for HIV testing in Africa, as well as policy reform and measures to address health manpower shortages, are essential to ensure universal access to knowledge of HIV status.

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2008-02-03
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