Testing for HIV is essential to stop the epidemic, according to research. So it’€™s heartening that the 2008 National HIV prevalence survey shows that the proportion of people who had ever taken an HIV test has doubled in the last six years. About 21% of South African males had tested for HIV in 2002, compared to 43%, this year. Among females, the proportion rose from 21% to about 56%. Although encouraging, the fact that the majority of South Africans haven’€™t ever tested for HIV is of concern. It’€™s reflective of our public health system, says the Southern African HIV/AIDS Clinicians’€™ Society President, Dr Francois Venter.

‘€œWe know the quality of our testing is poor. We know that the systems of health that accommodate people once they test positive are very poor. We have an alarming amount of data suggesting that when people test HIV-negative, that there’€™s behavioral disinhibition, but we don’€™t do anything about that, and yet we carry on with this HIV testing stuff, which is actually very, very expensive.

I think that we need to do some harsh self-reflection in the HIV-testing world to say, ‘€˜how can we provide care that is suitable to the people, that respects human rights wherever we can, respects privacy wherever we can, that, at least, expands the debate to make sure that the testing is actually valuable to the country, to the programmes that are engaged and to the people that are accessing them’€™?’€, he said.

Dr Venter decried the current HIV testing system, saying that ‘€œone of the biggest failures of HIV testing, throughout the country, is the fact that we test people when they are sick. There’€™s been a startling lack of creativity in HIV testing’€.

He added that creativity is crucial, notwithstanding the apparent increase in the uptake of HIV testing.

‘€œI think the fact that we have increased HIV testing in this country many times over ‘€“ not nearly to the point at which it should be ‘€“ but the fact that the so-called magical disappearance of stigma, the magical appearance of the antiretroviral clinics, the magical increase in CD4 counts and starts of initiation of antiretrovirals, hasn’€™t materialised in any meaningful way across the country, is actually an indictment on the HIV testing community and the culture that we are all part of. We need to start asking for creative ways, but in a way that suits our patients and suits the community and suits the people actually accessing the testing’€, said Venter.