Mon, Jul 12, 2004 - Page 5 News List

UN urges routine AIDS test policy


An elephant gives out condoms before the opening of the 15th International AIDS Conference in Bangkok yesterday.


A major shift toward routine AIDS testing is needed, UN health experts say, because the current strategy of leaving it to patients to request HIV tests is not working in the developing world, where 90 percent of those infected have no idea they are carrying the virus.

Announcing the change in policy ahead of yesterday's opening of the International AIDS Conference, the UN AIDS agency and World Health Organization said countries where HIV is widespread and where treatment is available should test routinely. The policy does not amount to mandatory testing because patients still could opt out.

"The environment of AIDS is changing dramatically. Not only is there a globalization of the epidemic across Asia and Eastern Europe, but there is also a fundamental shift in the response, where treatment is becoming far more available," said Dr. Peter Piot, chief of UNAIDS.

Patients who visit clinics "for whatever reason" but who are not offered HIV tests represent missed opportunities for early diagnoses of AIDS, or even chances to discuss prevention, Piot said. "At the moment there are millions of missed opportunities," he said.

Routine testing would come in tandem with safeguards against the discrimination that many patients fear facing once people know they are infected.

"We are recommending a complete package in which testing and counseling, working on stigma, social mobilization and the offer of treatment happen simultaneously," said Dr. Jim Yong Kim, director of the WHO's HIV department.

WHO has mulled routine testing for years but has not announced it as UN policy until now. It got behind the idea after doctors reported seeing patients they strongly suspect are HIV-positive but feeling constrained by the old policy requiring patients to initiate discussion about a test.

"We thought that we had to take a much stronger stand," Kim said, adding that the test must be always be consensual, confidential and accompanied by counseling.

WHO has decided that access to lifesaving therapies outweighs the need to avoid potential discrimination, Kim said.

Botswana, which has the highest HIV prevalence in the world, shifted to routine testing in January, with the proportion of patients tested for HIV jumping from 20 percent to 80 percent.

Almost everybody who comes into a health center is given a test unless they object, said Dr. Ernest Darkoh, head of Botswana's national AIDS program.

"You realize very quickly that the whole paradigm of voluntary counseling and testing does not make sense at all in a country where you have a generalized epidemic," Darkoh said. "It just means that you reach people late. At that point they've already lost their livelihoods -- at the minimum -- because they are too sick to be working."

"In this incredible race against time" a doctor must get patients onto anti-AIDS drugs in "an emergency room situation. It's not sustainable," he said.

The World Health Organization aims to get 3 million people in the developing world on HIV medication by the end of 2005.

Testing must be ramped up substantially to achieve that goal -- with a half-million people tested per day, according to the Global Business Coalition on AIDS, a network of more than 150 companies.

"A lot of things have changed in AIDS in the last 20 years, but the testing policy has largely stayed the same," coalition executive director Trevor Neilson said.

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