Zunyou Wu, Bejing, China
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.
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
for HIV/AIDS Surveillance
Academy of Preventive Medicine
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.