Health professionals should routinely offer to test people for HIV, instead of waiting for patients to request it, according to new advice from the United Nations.
In making the recommendations, the World Health Organization and UNAIDS are underlining the need to identify the millions of HIV-positive people worldwide who need treatment. The WHO estimates that approximately 80% of HIV-positive people in developing countries are currently unaware of their status.
"If we are serious about ensuring universal access to drugs, there has to be a fundamental change in the approach to HIV testing," said Dr Kevin De Cock, director of the WHO's Aids department. Patients typically have to ask for an HIV test before it is performed, though some countries, such as Botswana, Malawi and the United States, now attempt to incorporate HIV tests into everyday services.
The UN now advises health workers to test patients for HIV as part of standard medical care, but only with the patient's informed consent.
Yet there are questions about how the cash-strapped countries in Africa, who have most of the world's Aids patients, might adopt these guidelines. Of the estimated 40 million people living worldwide with HIV/Aids, nearly 65% are in Africa. Because current estimates of the number of HIV/Aids patients include people who don't know their status, experts do not expect the numbers to rise dramatically if more people are tested.
Already a long waiting list
Though universal testing will certainly identify more HIV-positive people needing lifesaving anti-retrovirals, there is already a long waiting list: nearly 5 million people in sub-Saharan Africa are still without treatment. Identifying more Aids patients whom countries cannot afford to treat threatens to create an even bigger backlog of people who know they are sick, but have no access to care.
Most Aids experts believe that increased HIV testing will help, even if the conditions are not perfect. "No one wants a situation where people find out they're HIV-positive and can't get anti-retroviral treatment," said Jennifer Kates, vice president and director of HIV policy for the Kaiser Family Foundation. "But if we waited until everything was perfectly aligned, we would never respond." In addition, not everyone who tests positive for HIV will need drugs right away. Some patients may only need to be monitored, while others might benefit from things like nutritional advice.
Another benefit of testing: Past studies have also shown that once people are aware that they are HIV-positive, they tend to practice safer sex - which could give prevention efforts a boost.
4 million health workers needed
Africa's weak health infrastructure, though, is a huge stumbling block. The continent urgently needs at least another 4 million health workers to fill the gap, according to the WHO. Without doctors and nurses to administer the HIV tests or to provide the necessary treatment when patients are identified, such guidance will create even more stress for Africa's already fragile health systems.
Still, the new testing procedures should mean that HIV patients are found earlier.
"The biggest problem we have now is that our health care systems are overburdened with very sick people who come in too late," said Zackie Achmat, chairman of South Africa's Treatment Action Campaign.
It is long overdue
"These new guidelines are long overdue," said Achmat. "We cannot deal with the burden on the health care service if we don't prevent people from becoming so sick that they become a supreme burden on it," he said.
Increased HIV testing and the treatment and infrastructure it ultimately entails will require more money, yet no new funds have been announced to help countries implement these policies. The UN estimates that the fight against Aids in 2007-2008 requires US$22 billion, and there is still a considerable shortfall. Last year, the deficit for global Aids programmes was about US$6 billion.
While health authorities would like to see the new UN
recommendations adopted as soon as possible, much will depend on whether countries decide to follow their advice.
"I hope that countries start implementing this immediately," said the WHO's De Cock. "But we know you can't just flip the switch and change everything in one day." – (Sapa-AP)