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Frerichs, R.R. Criteria for HIV Testing in Asia.

SEA-AIDS Network, October 6, 1997

R.R. Frerichs Posting

While in Asia these past weeks, I gained fresh insights to the way HIV is being addressed in the region. Partially this came while I was in Myanmar with a UN team to evaluate their sentinel surveillance program and partially while in Thailand to help conduct a policy workshop at Chulalongkorn University on HIV control. As in prior years, we had workshop participants from throughout the region (i.e., 32 from 11 countries) and had much thoughtful discussion.

In trying in our policy workshop to address the reluctance to consider testing options, we asked the participants to cite criteria they might use to decide if HIV testing is warranted in one group or another, and the forms of testing they might use. Criteria that surfaced included importance or magnitude of the problem, cost, coverage, and benefits and consequences of the decision.

We also asked them to consider what research might be done to address their concerns, so that clearer advice could be given to policy makers. We considered testing of blood donors, sentinel groups in surveillance programs, couples intending to marry, couples intending to have children, pregnant women, prisoners, STD patients and the general population. We also suggested that if testing was to be done, their proposed strategies might include testing that is unlinked anonymous, voluntary anonymous, voluntary confidential, routine confidential, mandatory or compulsory.

It was an interesting exercise that SEA-AIDS members might also like to contribute to, especially pertaining to countries in the region. Some like areas of India, Myanmar, Thailand and Cambodia have high levels of HIV infection, while others like China, Laos, Vietnam and Papua New Guinea may be more regional in their epidemics, and still others such as the Philippines and Indonesia seem to have lower levels of infection. Clearly testing strategies for low prevalence areas will differ from those carried out in high prevalence areas, since cost of detection would be formidable in the former, but more reasonable in the latter.

While most Asian countries accept mandatory testing of donated blood, they are less willing to mandate premarital or prenatal testing, feeling that this decision should be left to the couple or the pregnant woman. Yet as is now being debated by women's groups in Africa, in high prevalence regions such voluntary testing seems more adverse to women than men, since men are more likely to be initially infected and women to be susceptible, and to infants rather than their mothers, since without testing many more children would become infected.

When testing is left voluntary, will women in Asia be able to encourage their future husband to be tested and to share with them the results? Or would they be better protected by a government mandate that all married couples must be tested for HIV and syphilis and counseled as couples rather than individuals?

If data for decision making are not available, would research investigators be encouraged to evaluate the utility of mandatory testing in high prevalence areas -- both premarital and prenatal -- or should such forms of testing be left only to blood, no matter how common HIV is in the population?

Intriguing questions that need to be answered. I look forward to reading if others in SEA-AIDS have criteria of their own (i.e., considerations for decision making) that should be addressed when viewing testing strategies in local Asian settings.