I am responding to Dr. 'Ditch'
Townsend who commented about my June 10 posting. Before starting, I should point out that I do not know
and thus have no personal feelings towards him.
Instead I am merely reacting to what was written by someone, who happened
to be named Dr. Townsend. He also does not know me, so his comments about
my posting were taken in the same spirit (i.e., not personal). Dr. Townsend
raises an interesting point when he writes about context (what he describes
as a "third dimension"), suggesting that testing issues may be different
in developed versus developing countries. This certainly could be true.
While the testing policies that are being addressed in our correspondence
may be intended for developing countries, the funds to support these policies
often come from wealthier societies or from international agencies such
as UNAIDS or UNDP that derive much of their support from economically developed
countries. What is considered standard or ethical practice in prosperous
nations has a dramatic effect on what is being done in poorer societies.
Dr. Townsend provides an interesting example of this phenomena. He writes,
..."the availability of personal testing in a developed context (e.g. the
UK) is defensible. But in Cambodia recently, doing some project development
consultations, I did not feel I could endorse a proposal to actively promote
and provide HIV testing."
If his reluctance to endorse HIV testing in Cambodia is merely an opinion
which is subject to debate and discussion, then all would be well. In this
kind of free exchange of ideas, the best argument would win out, where
"winning" means optimum benefits for the Cambodian people.
But what if there is no free exchange? What if the lack of endorsement
by Dr. Townsend had an influence on the funding agency, and no tests were
made available to Cambodia? Then the origins of his opinions would be important
to understand, including the cultural context in which his thoughts were
Since for most people in the developing world, the origin of their
consultant's thinking is in the West, the possible shift in thinking towards
personal screening that is occurring in the United States should be of
interest. Once this shift of opinion becomes more widespread throughout
the United States, Europe or other donor societies, then funding for personal
screening efforts will increase in the high-prevalence countries of Asia,
Africa and South America, and new testing strategies that feature personal
screening will be tried and evaluated.