November 26, 1998
"Ditch" Towsend, Malaysia
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
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.
have yet to see evidence that testing programmes can initiate or even
significantly contribute to the process of normalisation, let alone in poor
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.)
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).
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).
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.