DURBAN – If access to HIV treatment does not exist, should government’s promote voluntary testing and counselling among its citizens? This was one of the issues debated at the AIDS 2000 conference this week.

Speaking in favour of voluntary testing and counselling, Dr David Miller of   UNAIDS argued that voluntary testing and counselling should be promoted regardless of whether or not basic preventative treatment, let alone expensive anti-retroviral treatment, was available.

He argued that voluntary testing and counselling is “the entry-point for the provision of care and support” in any setting. According to Miller, apart from increasing people’s ability to cope with their disease, voluntary testing and counselling also facilitate prevention and the destigmatisation   of HIV/AIDS.

Dr Joe Thomas disagreed and argued that while voluntary testing and counselling should most certainly be available to those who choose it, it should not be actively promoted as a public health policy “in the absence of an enabling package of care and support facilities.”

In countries where the entire per capita health budget was four US dollars, it made little sense, said Thomas, to spend that money on an HIV test.

HIV testing is a diagnostic tool which is being misused as a prevention strategy in the absence of effective treatment, said Thomas. He also argued that HIV testing is often initiated by health care providers who use it to discriminate against HIV positive patients in the allocation of limited treatment and care resources.

Delegates who supported the promotion of voluntary testing and counselling pointed out that “we are here to break the silence around HIV/AIDS. We should be bold and encourage our people to know their HIV status.”

However, a delegate from Zimbabwe argued that much of the zeal behind the promotion of voluntary testing is the product of UNAIDS funding. He pointed out that while many studies had measured the benefits of testing, few if any had measured the suffering and harm to the individual that testing also caused.

“People who are tested and counselled are then left to make it on their own. As medical practitioners, we should at least do no harm,” he pointed out. – Health-e News Service.