‘€œWe know, despite the fact that things are improving because we have effective treatment, stigma persists. People do not want to go to their local clinic, although testing is available. The messages are ineffective, at best, and offensive, at worst, and that’€™s common. And we do have inequality in the clinics. You say it should be private. Well, not every clinic has a space where the single counselor can tend to the 80 people queuing to get VCT. So, how is that private?’€ , said Christa Dong of the Integration of TB and HIV Care (ITEACH) programme at Edendale Hospital in Pietermaritzburg,     explaining what they found to be reasons why people were not likely to test for HIV at government clinics.

Women seem to access testing more readily than men in South Africa. Researchers believe that this is due to fears amongst men that if HIV-positive, their status will be disclosed through testing, and that stigmatization will follow. Thus, the pilot programme predominantly recruited a cross-section of men from different settings of KwaZulu-Natal, starting last October. Over a million men were targeted through cell-phone text messages and over 300 000 participated.

The result was that ‘€œmen wanted a new option to the current method of HIV testing’€, says Zinhle Thabethe, one of the researchers. ‘€œThey said they wanted HIV self-testing’€, she said.

Testing for HIV as it’€™s done through the current Voluntary Counseling and Testing method, includes a compulsory counseling session before and after the test and the actual test is done by a health worker. Participants in Project Masiluleke received self-test kits with instructions on how to use it. The package also contained a number to call to speak to a counselor if they needed further assistance or counseling.

‘€œThe counselors, every single one who participated this way, said they preferred it. They said, ‘€˜oh, that was nice. I could tell them everything I needed to’€™. Not just the patient, but the counselor also said ‘€˜I appreciate this thing. It lets me relax and I can give this information and it’€™s not so emotionally burdening’€, said Christa   Dong.

Results of the pilot programme have drawn mixed reactions.  

‘€œI’€™m concerned about this self-testing’€, said Lydia, a clinician working in Tembisa, on Gauteng’€™s East Rand.

‘€œMaybe when this person buys the test kit there should be some accountability about the person who is selling it, so that they can have a counselor calling that person rather than waiting for that person to call the counselor because we have discovered so many people who attempt suicide even after being well counseled’€, she added.

But Dr Francois Venter, President of the Southern African HIV Clinicians’€™ Society, relished the results.  

‘€œI think the worst place to learn your HIV status is in a health care facility; and I really think that we need to be looking for much more creative ways for moving that testing out; and that if the health care facility is our only option – in fact, if it’€™s our best option – then, we are in deep, deep trouble. We really need better and creative ways and I hope that in two years’€™ time we won’€™t be sitting around here and saying ‘€˜most people are still testing themselves through insurance policies and in the health care facility’€™, but that if it’€™s self testing, or whatever else it is, there are more creative ways of accessing your HIV status’€, he said.