Know your status

THE mounting Acquired Immune Deficiency Syndrome (AIDS) crisis has prompted a radical shift in the global human immunodeficiency virus (HIV) testing policy - from pushing a purely seeker-dependent service to one that aggressively and routinely promotes HIV testing in health facilities to boost access to treatment and prevention. Getting tested for HIV infection could soon become as routine and as normal as having your temperature checked when you go the doctor - although you still have the right to decline the test.

Those who test HIV positive and are found to require treatment will be given the opportunity of accessing timely care and anti-retroviral test (ART). Knowing one's HIV status will also help those infected to take precautions so that they do not infect others unwittingly, thereby contributing to HIV prevention efforts. Routine testing will be promoted globally through a "Know Your Status" campaign designed to boost access to ART and HIV prevention on a large scale across the developing world, according to experts at a meeting convened by the Global Business Coalition on HIV/AIDS (GBC), on the eve of the inauguration of the 15th International AIDS Conference.

The new policy comes in the wake of the global failure of HIV testing strategies that rely on testing only those who seek the service at Voluntary HIV Counselling and Testing (VCT) centres. Widespread stigma and ignorance about HIV/AIDS has led to a situation where very few people actually use the voluntary testing services.

Experts hope that the new testing policy will help realise the goal of getting three million positive people on ART by the year 2005 - popularly referred to as the `3 by 5' initiative - which was launched by the World Health Organisation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) last year. "Ninety per cent of those infected in the world are unaware that they carry the virus. We estimate that to reach the goal of 3 by 5, each day 5,000 of them need to be brought on to treatment," observed Dr. Peter Piot, Executive Director of UNAIDS. "This would mean that 500,000 people need to be tested for HIV every day in order to detect 5,000 who require ART."

The new testing policy is already being implemented in Botswana where 38 per cent of all adults are HIV positive - the highest adult infection rate in the world. The availability of ART in Botswana has driven up the demand for HIV testing by 80 per cent within a few months.

The growing demand for ART and HIV testing can only be satisfied by further reductions in anti-retroviral drug prices and the availability of cheaper and better tests for HIV, according to Richard Feachem, Director of the Global Fund for AIDS, tuberculosis (TB) and malaria. Brian Brink, vice-president (health), of Anglo American, a mining company in Africa, said that the new testing policy using rapid HIV testing kits such as Ora-Sure, which checks oral fluids rather than blood for HIV, had helped bring 1,500 miners on ART and 95 per cent of them were continuing to work normally. "The earlier someone gets tested and gets on ART, the more we can help preserve health and productivity," he said.

Addressing concerns about the possible discrimination of people with HIV in the workplace and in society, Dr. Jim Kim, director of the Department of HIV/AIDS, World Health Organisation (WHO), said: "The new `routine' HIV testing policy will continue to be based on the three Cs of consent, confidentiality and counselling. Alongside, there has been social mobilisation to lift the stigma surrounding AIDS and this included putting in place new legislations that will protect the rights of people living with HIV." Trevor Nielsen, executive director of the GBC? said that the new testing policy and all efforts to implement it on a global scale would be carried out jointly by a host of organisations with the business sector playing a critical role.

From the early days of the epidemic, the peoples of the South have looked to the U.S. and the countries of the European Union for funding, scientific breakthroughs in drug and vaccine development and for mobilising political leadership to action. Europe and the U.S. continue to be the largest donors but "the disease continues to outpace our response. Twenty million people have died of AIDS so far, yet current spending is less than half of what will be needed by 2005," noted Peter Piot.

UNAIDS estimates that the world will need $12 billion by next year to mount prevention programmes in developing countries, $7 billion more than what is now being spent annually. By 2007, the figure will swell up to $20 billion. The funding is expected to rise, but will be far outpaced by the ever-growing need over the next decade. Over time, it is expected that the funding increases will slow down even as the estimated requirements will continue to pile up.

A NEW joint study by the Asian Development Bank (ADB) and UNAIDS reveals that the Asia-Pacific region lost $7.3 billion in 2001 towing to AIDS. Some 10 million adults and children will become infected in Asia between 2004 and 2010 causing annual financial losses of $17.5 billion, washing away the slim gains made in poverty eradication. If current trends of infection persist, till 2015, an average of over five and a half million people will be impoverished every year because of AIDS in India, Cambodia, Vietnam and Thailand alone. ADB estimates that $1.5 billion was needed to finance the Asia-Pacific region's response to AIDS in 2003, but that only $200 million was available, pooled from all sources. From 2007 to 2010, the annual need is expected to shoot up to $5.1 billion, which means that national governments must contribute finances to respond to the epidemic or face the prospect of having to spend many times over later.

Lamenting the fact that the mind numbing toll taken by the epidemic has not stirred leaders into making a political commitment to fight AIDS, Dennis Altman, president of the AIDS Society of Asia and the Pacific, observed: "AIDS is seen either as a manageable problem of the rich world or alternately as a major problem of Sub-Saharan Africa. In the Asia Pacific we have populous countries whose low HIV prevalence rates mask the fact that they refer to huge numbers of infected people. It is difficult to get political leaders to focus on a crisis that is not yet apparent and that may become apparent long after they personally are in power. Political leaders tend to think only about the next three weeks. There is also a great deal of hypocrisy surrounding AIDS and hypocrisy is killing people."

The presence of United Progressive Alliance leader Sonia Gandhi in her capacity as the chairperson of the National AIDS Advisory Council of India, was seen as setting an example for other Asian leaders. Former South African President Nelson Mandela came out of retirement to make one more attempt to get world leaders to step forward and take up the responsibility of dealing with HIV/AIDS. "The day after tomorrow, the 18th of July, will be the day I turn 86," he said. "There could be no better birthday gift than knowing that there is renewed commitment from leaders in every sector of society to take real and urgent action against AIDS. We know what needs to be done - all that is missing is the will to do it. Allow me to enjoy my retirement by showing that you can rise to the challenge."