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Frerichs, R.R. Rapid tests

SEA-AIDS Network, June 6, 1996

Posted in response to:

SEA-AIDS, May 27, 1996

From Zunyou Wu, Bejing, China

To rapid test issues raised by Professor Frerichs, I want add a few comments based on our experience in China. In the surveillance of STDs, it is noticed that a considerable proportion of STD patients took medicines by themselves before seeing doctors. It is unknown how many STD patients treat themselves and never see doctors. There is no prescriptions needed for purchasing medicines at pharmacies in China. Therefore, people have readily access to any medicine they want if they have enough money. 

If an easy-rapid test kit (no machines needed) which can be used to test several STDs including HIV simultaneously using either saliva or urine could be developed, STD patients could easily do self-screening by themselves. It is expected that the testing will help to prevent some further transmission of STD/HIV.

Zunyou Wu

Center for HIV/AIDS Surveillance

Chinese Academy of Preventive Medicine

27 Nanwei Road

Beijing 100050, China

R.R. Frerichs Posting

To address the need of which Dr. Wu wrote for inexpensive rapid tests for sexually transmitted disease, The Rockefeller Institute has pledged several hundred thousand dollars in support for persons or organizations developing such a test. They have joined the World Health Organization (WHO) in wanting to stimulate treatment or prevention of the more than 300 million new cases of curable sexually transmitted diseases (STDs) that occur each year in the world, including four of the commonest STDs - gonorrhoea, chlamydia, syphilis and trichomonas.

Unfortunately, no inexpensive STD rapid tests have yet been developed, even with the substantial Rockefeller prize money. What remains curious is that the Rockefeller Institute has not extended their financial offer to developers of inexpensive HIV tests, a disease that is easily preventable with notification and, according to WHO, is present in 17 million people throughout the world. By using condoms or avoiding exchange of sexual fluids, HIV can be prevented from spreading from spouse to spouse, but only if incentive comes from tests that shown the virus is present.

From what Dr. Wu relates, simple screening tests for HIV and other sexually transmitted diseases would be welcome in China. Such tests for HIV would certainly protect young people from entering into marriage with an HIV infected spouse, or help infected women to avoid transmitting the virus to their newborn children. The benefits would also be great for STD prevention, once STD rapid tests are developed.

While inexpensive rapid tests are still a distant dream for most sexually transmitted diseases, they are quickly becoming available for HIV. Those countries that recognize the right of citizens to learn of their personal health will gladly accept such tests. Others that take a more paternalistic view of their people, however will keep inexpensive rapid HIV tests out of reach, fearing the potential consequences of uncontrolled testing. The ethical issue facing public health officials in most countries remains clear the need to balance the reduction of HIV that would likely follow widespread distribution of home tests and some physical and mental abuse, versus continued viral transmission but less psychological harm that comes with high standard, but limited, counseling and testing programs. As an epidemiologist and public health professional who has specialized for years in problems of developing countries, the theoretical preference is obvious.

Of course, once widespread HIV testing is deemed acceptable, the process should be started with small regional programs and much monitoring, to make sure that individual harm does not exceed societal benefits.

Being willing to conduct such research, and responding in a compassionate manner to the findings, defines the practice of progressive public health.