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R.R.
Frerichs Posting
This message is meant for colleagues at UNAIDS or other international
institutions who might be following viewpoints on HIV/AIDS that are moving
back and forth here in the United States.
In the past few years I have
encouraged GPA and then UNAIDS to engage in a wider discussion of HIV detection
issues, leaving preconceived notions behind and considering feasible and
inexpensive ways to reach the majority of people in high HIV prevalence
developing countries of Asia. I presented many sensitive issues including
screening versus diagnostic tests, pre- and post-test counseling versus
regular discussions with a physician, only reporting of HIV status to patient
versus reporting to patient and health departments, and partner notification
versus only subject notification. I further tried to get clarification
of voluntary versus routine versus mandatory testing, so that we could
determine the strategic value of each approach at identifying HIV infection
and preventing further viral transmission. Yet such discussions did not
take place, at least not in an open electronic mail format that others
could appreciate and learn from. Instead, silence dominated and positions
hardened.
In the mean time, here in the United States we continue to debate testing
and disclosure issues, with CDC rather than UNAIDS taking the leadership
position. California is now the pivotal state in the US debate over named
HIV reporting versus unique identifiers, which if resolved for named reporting
would lead to a national reporting system for those who are infected. Once
this takes place, persons in developing countries will likely read about
the change and want guidance from UNAIDS or other international agencies
on what they should do.
Will the guidance be left to CDC or academic consultants
or will UNAIDS provide wise (i.e., practical) counsel in a leadership role
similar to what the World Health Organization has done for many diseases
and the World Bank is now attempting to do with selected diseases? Maybe
or maybe not.
My hope is that UNAIDS will study the debate in the US, assess the applicability
for developing countries of Asia, and make recommendations that safe-guard
Asian populations from further viral transmission. No doubt UNAIDS is monitoring
in detail the ever-growing body of open discussion, journal articles and
media coverage of the crucial named HIV reporting issue. Yet the silence
from UNAIDS might not be so deafening if people working in the HIV/AIDS
field were invited to participate in these monitoring and interpretation
efforts, with UNAIDS serving as a neutral arbitrator that encourages creative
thinking and experimentation. Using electronic forums such as SEA-AIDS
or the International AIDS Economics (found at http://www.iaen.org/) would
be a good place to start.
An example will appear in November when the International AIDS Economics
site hosts the online discussion, "The cost-effectiveness of HIV prevention
strategies." Hopefully they will address some of the broad financial constraints
that now face government and NGO officials in Asia, and the benefits of
HIV detection at the individual level.
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