HIV home testing – should we or shouldn’t we?

50e0e621e158.jpgIn a recent open letter to the public, three HIV/AIDS specialists suggest that HIV home testing should be made readily available to the public. The letter argues that South Africans should be able to take an HIV test in the comfort of their homes. One of the authors of the letter is Deputy Executive Director of the Wits Institute for Sexual Health and Related Diseases at Wits University, Professor Francois Venter. He says the country is in crisis and innovations like the HIV home testing kit will help us understand and deal with the extent of HIV infection.

‘€œI think this country is in denial about HIV. I think the problem is that our government, the churches, unions and so on… everybody is able to say they are doing their bit for World Aids Day, then they pack up for the rest of the year. This country is in absolute crisis at the moment. Almost half of all deaths are related to HIV. We have a massive orphan population, we see huge impacts on our working population, and it has implications on our grants systems. The healthcare system is under a huge amount of pressure from people falling ill, yet we can mobilise the whole country behind the World Cup, the Gautrain but we cannot mobilise ourselves around HIV’€.

Professor Venter argues that home testing is also about convenience. He says it needs to be taken into account that some people may not want to be put through the whole process of waiting in queues or being counselled when taking an HIV test.

‘€œPersonally, I sometimes would like to know my HIV status and I don’€™t want to go to the clinic. I don’€™t want to go through the rigmarole of counselling. I don’€™t want to repeatedly go through the same process again. I want to do it when it suits me, to be honest. And at the moment I don’€™t think our HIV services suit most of us’€, says Professor Venter.

However, not everyone is in agreement. The South African Medical Association, SAMA, has spoken out against HIV home testing, saying it has the potential of damaging many peoples’€™ lives. It says key to HIV testing is the pre and post- counselling and that that component should not be taken for granted. SAMA Chairperson Poppie Ramathuvha explains why.

‘€œWhen you do your pre-test counselling, you counsel an individual in such a way that he or she is sure that she is positive before you even do the test. So, when you do the test and find that they are negative, it’€™s a bonus. When you counsel a person you have to be sure that even if they are positive they’€™ll still go home knowing it’€™s okay. Without such a process it’€™s going to be a problem’€.

Dr Ramathuvha added that there could be severe repercussions to testing yourself without a professional at hand.  

‘€œWhen you are alone you say to yourself: ‘€˜Am I going to die? I know there are ARV’€™s, but how do I access them?’€™ You don’€™t know which regimen you are supposed to be on. Many tests need to be done on you, but you then go and find means to get ARV’€™s, and then you access wrong ones that further complicate things. Or, immediately when you test and it comes back positive you commit suicide. Many of us when we go for an HIV test it’€™s very stressful, including myself, knowing everything I do about HIV. But when I go for that test I need somebody with me, otherwise I become scared’€.

The Treatment Action Campaign, TAC, has also added its voice to the debate. It has reinforced the importance of pre and post-counselling when taking an HIV test. TAC’€™s Ekurhuleni Branch Representative, Luckyboy Mkhondwane, says an HIV test is more complicated than a pregnancy test.

‘€œIn order for one to do an HIV test you have to be in your right mind, that’€™s why we prefer someone to go for counselling. But if you go and buy your own home test and do it, it will have many implications that are bad because you won’€™t have the coping mechanism that someone who has been to a clinic has. You need to be prepared; you can act brave and think you are ready to know your HIV status, but when you do it’€™s different’€, he says.

With the focus being on World Aids Day this week, many South Africans still don’€™t know their HIV status and government has embarked on a massive effort to encourage the public to get tested with the launch of the HIV Counselling and Testing (HCT) campaign in April. But Professor Francois Venter argues that the country’€™s current HIV testing system is not yet up to scratch, hence the need for the home kit.

‘€œThe process of testing by counsellors, in particular and the pricking of patients by nurses… there have been lots of quality over-sight problems. People haven’€™t been waiting long enough to get the test read, the counselling has been very poor quality and the post-counselling hasn’€™t referred people into the system. What we’€™re seeing now at the clinics is that instead of people waiting for 15 minutes they take 8 minutes to read the test, and that’€™s not good. So, I do worry about the HIV testing system in our country and if we don’€™t focus on the quality of that test, particularly of reading the test result, we run the risk of undermining what is a very important programme. South Africans need to know their status and to trust the systems that give them that’€, says Professor Venter.

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