Some interesting issues surround HIV testing surfaced at the recent
4th International Congress on AIDS in Asia and the Pacific, held in Manila,
the Philippines from October 25-29, 1997. As noted both at the Conference
and UNAIDS websites, clinical research is
now underway in various developing countries to develop a less expensive,
shorter course of antiretroviral treatment for pregnant HIV-positive women
in poor countries. Studies conducted by UNAIDS in South Africa, Tanzania
and Uganda and by CDC and the MOPH (Ministry of Public
Health) in Thailand aim to compare the use of
short course antiretroviral treatment to no treatment at all, or a
to find a feasible way to prevent mother-to-child transmission in developing
countries. The aim as stated by UNAIDS (and likely by MOPH/CDC) is not
only to find a less expensive treatment, but also to find one that may
be given over a shorter period of time, since many women in poor countries
do not attend ante-natal clinics until very late in pregnancy, if at all.
In a poster presentation in Manila, Wimol, Shaffer et al (MOPH/CDC) reported
on the progress of their on-going short course zidovudine trial to reduce
perinatal HIV transmission in Bangkok. Likely the results will be
available early next year, perhaps in January or February. If found
to be as effective as full-dose AZT (i.e., the earlier 076 trial - Connor
et al. NEJM 331(18), 1173-1180, 1994), public health officials in Asia will
have available another reason to test for HIV, needing to find the infection
early in the course of the disease.
But what is being done in Asia to prepare societies for such a finding,
either from the coming Thai study or arising from other UNAIDS trials?
Will we need to start from the beginning to encourage more widespread testing,
or will countries have experience encouraging pregnant women and others
to know their HIV status?
From what I heard in Manila from Thai colleagues,
health providers and women are already preparing for possible good news.
Several knowledgeable health professionals told me that more than 90% of
pregnant women are routinely being tested in Thailand, many of whom pay
up to 100 baht (or about $2.5 US) to partially compensate for the cost.
Have others now working in Thailand who are subscribers of SEA-AIDS found
this to be so?
Several questions come to mind. Is testing voluntary (i.e., with
informed consent), routine (i.e., no consent regularly asked for, but women
have the option of refusal) or mandatory (i.e., no option to refuse)?
Are the husbands informed or is the information shared only with the pregnant
women? Is counseling routinely offered, notably to those who test
negative? Is suicide or divorce among those who test positive a
problem in Thailand or are such outcomes infrequent? Who typically
pays for such antenatal testing, both before and now that economic constraints
have reduced the MOPH budget?
If able to address these issues, please share with the broader SEA-AIDS
network the experience in Thailand. Such sharing will help public
health officials throughout Asia who want to address such issues early.
The alternative, of course, is to sit by and watch people make mistakes
that otherwise could have been avoided.
Confronting HIV in India (Oct. 26, 1997 Slide Talk)
Issues in Home HIV testing (Oct. 27, 1997 Slide Talk)