POSTING 62: MORE THOUGHTS ON FEAR AND HIV TESTING 


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Frerichs, R.R. More Thoughts on Fear and HIV Testing. 

SEA-AIDS Network, December 1, 1998.

Posted in response to:

SEA-AIDS, November 26, 1998

From "Ditch" Towsend, Malaysia

Professor Frerichs (#58) provided us with a description of an interesting project from Thailand written by Laurie Maund. It emphasised the need to normalise AIDS in affected communities as a step in reducing the social problems faced by people who learn they are infected with HIV.

Such projects are incredibly important in the Asian context. (The Africa-derived 'Stepping Stones' resources may perhaps be of benefit in such community counselling/education initiatives.) However, they need to come BEFORE testing is promoted as the panacea for preventing the spread of HIV.

I have yet to see evidence that testing programmes can initiate or even significantly contribute to the process of normalisation, let alone in poor Asian contexts..

Having recently returned from Chiang Kham in North Thailand, I have seen how severely affected communities are now beginning to 'naturally normalise' AIDS where a few years ago, prejudice and associated social issues were even more marked problems for people with AIDS. This process seems to have arisen spontaneously - when each village (and many families) have had several members die with AIDS. I am told this process is already quite advanced in this district even in relation to much of the rest of Thailand. (Unless I misunderstand, this is similar to some of the normalisation seen to occur in severely affected African contexts.)

In such a context, I would begin to agree with Professor Frerichs, that social conditions might favour a strong testing programme -generally (hopefully) benefiting those discovered to have HIV (though again, I am not sure there is evidence that it would be useful in prevention).

However even then, I would worry about the opportunity cost for poor people (or Health Departments) spending what little money they had for the plethora of health and social needs, on test kits with a significant false positive rate under field conditions (let alone the money needed for confirmatory tests).

As an AIDS programme worker born, brought up and resident in Southeast Asia, I would counsel against injudicious promotion of testing in highly prejudicial and poor social contexts in the region.

Dr 'Ditch' Townsend

R.R. Frerichs Posting

In a recent commentary on normalization and the fear of HIV testing, Dr. Townsend wrote: "[programs to normalize HIV] need to come BEFORE testing is promoted as the panacea for preventing the spread of HIV." His emphatic BEFORE raises the question, can a stigmatized disease such as HIV infection be normalized in a society if it is not seen among friends and neighbors and the only publicity comes from sensationalized stories in the media? 

While he is suspicious of HIV detection efforts, Dr. Townsend seems to answer this question in a pro-testing manner when he writes of AIDS detection: "Having recently returned from Chiang Kham in North Thailand, I have seen how severely affected communities are now beginning to naturally normalize AIDS where a few years ago, prejudice and associated social issues were even more marked problems for people with AIDS. This process seems to have arisen spontaneously - when each village (and many families) have had several members die with AIDS." His response suggests to me that being aware of AIDS in the community (i.e., using the "eyeball" test to detect the disease) leads to normalization, at least in the setting that Dr. Townsend writes about. If so, I certainly agree and anticipate that being aware of HIV (i.e., using HIV antibody tests to detect the infection) will also lead to normalization in the community.

Rather then leaving the normalization process to the slower pace of natural social evolution, I favor having public health professionals and those working for NGOs move the process along, as was wonderfully illustrated by Mr. Laurie Maund in my earlier posting (#58). Including widespread HIV testing with programs that promote normalization (as is now occurring in Thailand) is certainly difficult for some to accept, but should be viewed as just another innovation to be tried and evaluated. There will always be many reasons given why new strategies should not be tried. The acceptance of such reasons helps some policymakers justify keeping things as they are. Unfortunately, recent news accounts from UNAIDS about dramatic increases in HIV levels in India, Cambodia and other regions of Asia remind us of the consequences of not developing (and evaluating) new options.

Instead of focusing on why HIV testing and normalization will not work, it would be helpful for all of us if people could share their positive experiences in Asia with detection and normalization efforts. What would be especially useful to learn about are innovative efforts to limit the spread in marriages from infected to susceptibles spouses.

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