POSTING 69: HIV TESTING -- FRUSTRATIONS AND CONDUCT 


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Frerichs, R.R. HIV Testing -- Frustrations and Conduct.

SEA-AIDS Network, January 25, 1999.

Posted in response to:

SEA-AIDS, January 22, 1999

From Graeme Storer, Australia 

I would like to respond to the posting from Dr Frerichs (#67).

In referring Rachel Sacks to the code of conduct, I feel that Dr Frerichs has side-stepped an important question raised by Ms. Sacks about this particular debate: namely, where would resources (in her words, "the few development dollars that still float around Asia") be best placed? Rachel Sacks points to an either-or dilemma: testing programs versus care and prevention, though I'm not sure that these "choices" need to be in opposition.

I would like to question two assumptions that underpin testing: first, that testing is advisable because those who test positive are in a better position to manage their health. This is an assumption that holds true in "developed" countries where treatments are affordable, and often subsidised. Second, that people will be both willing to test and willing to pick up their results. I'm not sure that this assumption is valid when testing is no longer anonymous, but linked to notification, which in my opinion, would lead to an increase in discrimination (either felt or enacted).

Graeme Storer

17/130 Brougham Street, Woolloomooloo

Sydney NSW 2011, Australia

R.R. Frerichs Posting

Graeme Storer in his thoughtful posting felt that I had "side-stepped an important question raised by Ms Sacks in her posting ((#67) namely, where would resources (in her words, "the few development dollars that still float around Asia") be best placed?" Perhaps he is right, but more out of oversight because of the unique personal nature of Sack's posting rather than neglect. Storer writes:


STORER ASSUMPTION ONE

I would like to question two assumptions that underpin testing: first, that testing is advisable because those who test positive are in a better position to manage their health. This is an assumption that holds true in 'developed' countries where treatments are affordable, and often subsidised.


MY RESPONSE

Storer's first assumption seems to be made from a medical point of view. The implication is that if treatment is not available, then there is no reason to diagnose a condition. While the logic of this statement might be acceptable for various forms of cancer, cardiovascular disease or other non-infectious disorders, the logic seems more assailable when considering a communicable disease such as HIV.

There are two intentions for testing:

  1. to make the infected person aware of his or her infection, and 

  2. to make the sexual or blood partners of the infected person aware of the risk they face with intimate contact.

Those concerned mainly with medical care tend to focus on 1) while public health professionals such as me consider more closely the benefits of 2). I also feel that in the absence of treatment, 1) remains important for the infected persons. They know to try to avoid opportunistic infections, to avoid passing the virus to intimate loved ones, and if pregnant, to consider alternatives to breast feeding.


STORER ASSUMPTION TWO

Second, that people will be both willing to test and willing to pick up their results. I'm not sure that this assumption is valid when testing is no longer anonymous, but linked to notification, which in my opinion, would lead to an increase in discrimination (either felt or enacted).


MY RESPONSE

I agree that many people are not willing to be tested, or if tested, would not return for their results. This has occurred in many countries, both developed and less developed. Where I differ with others is accepting this situation. I feel that it is important that people know they are infected and that their long-term sexual partners know as well. I also feel that public health professionals should help infected persons and their partners address the disease, helping them to avoid further transmission.

Without testing, it seems unlikely that a substantial proportion of married couples would use condoms on a regular basis. Thus without testing, the other partner will probably become infected. Such transmission would no doubt occur with testing, but hopefully if public health and medical professionals provide good advice, would occur at a lower rate. 

Finally, I agree that discrimination is a major problem for HIV infected persons. To address this issue, I have long favored strategies to normalize HIV, and in the past four years have included specific details for health professionals throughout the region in the HIV/AIDS policy workshop my colleagues and I conducted at Chulalongkorn University. Normalization is not just a good thing to do because it helps HIV infected persons. It also is a good thing to do because it opens the door to more extensive testing, which should create epidemiological benefits for the society.

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