Uganda: Mass HIV testing: Will it curb new infections?

By Joseph Kariuki
HIV prevalence rates are stagnating or even edging up slightly and health officials are taking a new look at controlling the scourge.

Advocates point to Cuba, where a combination of universal testing and aggressive early treatment has brought prevalence down to 0.1%, compared to 6.4% in Uganda.

But sceptics warn that such a policy could backfire unless carefully designed. The interest in universal testing comes at a time when HIV/AIDS continues to take a heavy toll on Uganda, 26 years after the virus was first confirmed in the country.

Every day, over 6,800 persons become infected and over 5,700 die from the disease, mostly due to inadequate access to HIV prevention and treatment services.

The HIV pandemic remains the most serious infectious disease challenge to public health says the 2007 UNAIDS/WHO report. Recent figures show HIV prevalence rate has increased by 0.2%, from 6.2% to 6.4% in Uganda, the country which hit world headlines in the 1990s as the first country to contain the HIV pandemic.

Dr. Elioda Tumwesigye, the HIV/AIDS parliamentary committee chairman says: “There is need to increase HIV testing if Uganda is to reduce the HIV prevalence rate. Tumwesigye was speaking during the AIDS Information Centre (AIC’s) annual meeting in Kampala recently.

He said the number of people who are testing for HIV has drastically reduced over the years. “Last year, one million people were tested, but 1.2 million babies were born. The actual progress is zero,” Tumwesigye said.

He said 27,000 babies are born with the virus and that 80% of the people who carry the virus do not know that they are infected and by the time they find out, it is too late. Tumwesigye, who is also the Member of Parliament for Sheema County, criticised AIC for turning its attention away from testing and counselling to emphasising care and support for the infected.

Speaking at the same function, the AIC executive director, Ronald Byaruhanga, said the organisation was looking for ways of providing ARVs and care for infected people. Tumwesigye, however, urged AIC to stick to its core stab of testing and counselling, which he said was more critical.

“We have relaxed on our prevention campaigns and we need to go back to that,” he said Byaruhanga, who also advocates mass testing, suggested that people should be allowed to test in the confines of their rooms.

“The essence of HIV testing is to know your status. If people can be allowed to access test kits and carry out their own tests, then the services will reach more people,” he said. Tumwesigye cited Bushenyi district, where door-to-door testing radically reduced the HIV prevalence in early 2000 from 8% to 3.1% in three years.

He said Parliament would work closely with AIC to ensure that the country moves towards an HIV-free generation through early diagnosis and treatment. Citing Cuba, where universal testing was done successfully, Tumwesigye said Uganda should borrow a leaf from the country to defeat the virus.

In its article, Cuba fights AIDS Its Own Way, by Anne Christine d’Adesky, the American Foundation for AIDS Research states that from 1986 to 1993, Cuba set up sanatoriums (hospitals) for HIV-positive people.

This much criticised quarantine kept people with HIV away from the general public. The quarantine ended in 1993, but Cuba retains an aggressive public health approach to controlling HIV, d’Adesky writes. Cuban HIV prevalence is now under 0.1% in adults between 15 and 49 years old — one of the lowest incidences in the world.

Most organisations involved in HIV testing are skeptical about the mass testing policy. Alice Anukur, Uganda Red Cross secretary-general says: “Unlike other diseases, HIV needs a lot of sensitisation and this may make the testing policy ineffective.” Dr. Victor Musiime, the head of paediatrics at the Joint Clinical Research Centre, says people should be allowed to make their own decisions on the matter.

“When you force people to do something, they tend to rebel and this may make the gain in the fight evaporate,” said Musiime while speaking during a massive HIV testing drive at Kisenyi, a slum in Kampala.

The WHO believes increased access to HIV testing and counselling is essential in promoting early diagnosis of HIV infection, which in turn can maximise the potential benefits of life-extending treatment and care. It would also allow people with HIV to receive information and tools to prevent HIV transmission to others. In its 2007 revised policy on HIV testing and counselling, WHO bars mandatory or coercive testing through one of its recommendations that warn:

“Provider-initiated HIV testing and counselling is not, and should not be construed as an endorsement of coercive or mandatory HIV testing.” This recommendation effectively limits the proponents of universal HIV testing from approaching HIV testing head on — the Cuban style.

This article was published in The New Vision, Uganda on Tuesday May 27th 2008