Saturday, December 1, 2018

HIV self-testing as a harm reduction strategy to prevent HIV/AIDS

The acquired immunodeficiency syndrome (AIDS) epidemic has had a devastating impact on human health from the time it was first reported in 1981 in the United States. Characterized by fear and ignorance, AIDS took a heavy toll of life in the initial years. The numbers were escalating and death was certain with no effective treatment available at that time. And, many died undiagnosed.

Significant progress has been made since then. While antiretroviral therapy (ART) has improved survival as well as the quality of life of people living with HIV, much more needs to be done.

A new report from UNAIDS “Knowledge is power - Know your status, know your viral load” shows that intensified HIV testing and treatment efforts are making a difference and are accessible to a greater number of people living with HIV. In 2017, three quarters of all people living with HIV (75%) knew their HIV status, compared to just two thirds (67%) in 2015, and 21.7 million people living with HIV (59%) had access to antiretroviral therapy, up from 17.2 million in 2015. However, the report also shows that about 9.4 million people living with HIV do not know they are living with the virus. It is this percentage of people living with HIV that need to be reached.

In 2014, UNAIDS set a treatment target of “90-90-90” to help end the AIDS epidemic by the year 2020. The aim is that 90% of all people living with HIV will know their HIV status, 90% of all people diagnosed with HIV will receive sustained ART and 90% of all people receiving ART will have durable suppression.

One of the biggest barriers to HIV testing is the fear of stigma and discrimination, which deters many from visiting the testing centers. Fear of being seen visiting the test centers, fear of the diagnosis itself and if diagnosed, fear that this information could be shared with their family, friends, or others are factors because of which people are afraid and hesitant to seek HIV testing.

Unless the uptake of HIV testing is increased, achieving the target of “90-90-90” will remain elusive. People with low access to testing facilities and those at higher risk that would otherwise not get tested are the ones that need to be encouraged to test themselves for HIV.

HIV self-testing has been suggested to improve HIV testing. It is a convenient testing approach for those who want to test themselves to know their HIV status in privacy. The WHO has strongly recommended “HIV self-testing” as an additional approach to existing HIV testing services. As stated by WHO, “HIV self-testing (HIVST) is an empowering and innovative way to reach more people with HIV and help achieve the first of the United Nation’s 90–90–90 targets – for 90% of all people with HIV to know their status by 2020”.

Under the National Strategic Plan on HIV/AIDS and Sexually Transmitted Infections (STI), 2017-24, the target by the year 2024, is to ensure that 95% of those who are HIV positive in the country know their status, 95% of those who know their status are on treatment and 95% of those who are on treatment experience effective viral load suppression.

India has a “Test and Treat Policy for HIV”, which means that anybody who is tested and found positive will get ART irrespective of CD count or clinical stage. India also has a “Viral Load testing” for all people living with HIV/AIDS to monitor the effectiveness of treatment of patients taking lifelong ART.

India, however, is in the process of implementing HIV self-testing. The policy on HIV rapid diagnostic tests self-testing is still under consideration. It should be implemented at the earliest.

As a harm reduction approach, HIV self-testing will help reach people who are at risk, including injecting drug users and may not otherwise test themselves for HIV. 

Knowing their HIV status will help them to start ART sooner to lead healthier lives and thence to improve their life expectancy and also reduce the risk of transmission of HIV.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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