The human immunodeficiency virus (HIV) continues to devastate populations throughout the world, and poses as one of the most vexing public health problems of the twentieth and twenty-first centuries.  As of December 2007, UNAIDS estimates that about 33.2 million people are currently living with HIV infection.  Furthermore, the organization estimates that during 2007 about 2.5 million were newly infected with HIV, while about 2.1 persons died of AIDS.  It is likely that  up to 95 percent of the HIV infected persons worldwide do not know they are harboring the virus. The figures for 2007 were revised downward by UNAIDS, who now base more of their findings on population-based surveys rather than sentinel surveillance of risk groups.  

Are there alternatives?

In 1994, Professor Ralph Frerichs suggested the creation of a simple screening test, using saliva, to detect HIV in the privacy of the home.  He reasoned that this would help susceptible persons avoid becoming infected. The idea was immediately criticized and fiercely resisted by many HIV/AIDS professionals and activists who focused more on protecting infected persons from social harm rather than susceptibles from the virus.  

Then between 1996 and 1999, Frerichs attempted to address various aspects of the HIV epidemic in South- and Southeast Asia where he  served as a consultant.  His postings were presented in SEA-AIDS, an electronic network organized by UNAIDS to provide information support services for people living or working with HIV/AIDS in the Asia-Pacific region.

As a public health educator, Frerichs' intention was to provide an epidemiological and public health point of view on HIV related issues.  Some of his 78 postings generated controversy and occasional rage, reflecting strong feelings about HIV in the international arena. Postings that respond to listed comments are cited in light blue

Issues discussed between Professor Frerichs and colleagues include early detection, personal screening, widespread HIV screening, mandatory and routine HIV testing, HIV normalization, partner notification, breastfeeding, and much more. These issues were also discussed at a Manila conference in 1997 in a tumultuous evening talk "Confronting HIV in India" and in a more staid daytime talk "Issues in Home HIV Testing" (see below).  In late 2002, the United States government approved a rapid finger-prick HIV blood test, overcoming arguments that have long hindered early detection.  CDC formalized the announcement in the MMWR.  The rapid testing device, however, initially came with restrictions which fortunately later were later removed.  In April 2003, the CDC urged HIV testing of all pregnant women, rather than relying upon them to volunteer.  In November 2003, De Cock and colleagues suggested a serostatus-based HIV prevention and care program for use in Africa (but also applicable in Asia).  More recently in 2006, Washington DC, site of the highest rate of new AIDS cases in the United States, launched a campaign urging every resident between the ages of 14 and 84 to be tested for HIV.  The campaign features oral swabs that delivers results in 20 minutes.

For personal HIV screening or screening of potential sexual partners, a test using saliva is the most appropriate.  Following more than a decade of saliva testing, the US Food and Drug Administration finally approved the first rapid saliva test in March 2004.  While simple to use, the FDA is not allowing the saliva HIV test to be sold directly to consumers for personal assessment, although this position may change. The struggles for a home HIV test were well-described in 2006. Until the matter is resolved, the impression remains that protecting susceptible persons from becoming infected is less valued with this single disease than safeguarding the rights of HIV infected persons to remain free from detection. 

In 2006, the United States CDC re-iterated its public health view by stating: CDC's overarching HIV-prevention goal is to reduce the number of new HIV infections and to eliminate racial and ethnic disparities by the promotion of HIV counseling, testing, and referral and by encouraging HIV prevention among both persons living with HIV and those at high risk for contracting the virus.  To this end, CDC now recommends widespread testing -- i.e., routine HIV screening of all persons aged 13-64 in health care setting. This prevention goal and approach remains equally relevant in the developing world.

Active debate continues in the United States on testing requirements and partner notification, with CDC in the fore.  The California Supreme Court has also entered the affray by ruling in mid-2006 that HIV infected persons who do not inform their partners can be held liable for transmitting the disease, providing additional incentive for partner notification.


The concept of rights is often raised by persons addressing HIV/AIDS, although they appear to overlook the indifference of the virus to such thinking.  Yet while many focus on what humans ought to do, more recently in 2007 some are employing the "rights" perspective to state what humans need to do in order to avoid continued infection.  Dixon-Mueller and Germain provided helpful guidance in The Lancet when they wrote that they ..."propose a reorientation of testing policies based on the premise that everyone needs to know their HIV status and that of their sexual partner to make informed sexual and reproductive decisions."  Perhaps others will recognize that the right to avoid infection is paramount to survival, and will consider the importance of pre-marital or pre-relations testing.

Being an infectious disease that moves slowly from person to person by direct contact, HIV should be easy to prevent.  The experiences of Uganda during the 1990s show that HIV can be prevented in the developing world, even with low-cost intervention strategies.  The Ugandan Ministry of Health conducted a successful HIV-prevention campaign with slogans such as ''Love Carefully,'' ''Love Faithfully'' and ''Zero Grazing'' - all aimed at partner reduction.  Cited below are details of this program, the ensuing controversies voiced at the 15th International AIDS Conference in Bangkok (2004) and thereafter, and the on-going abstinence efforts in Uganda. 

The Fidelity Fix 

Behavioral Change Is the Only Way To Fight AIDS

Museveni's ABCs

As AIDS Bureaucracy Cashes In, Prospect Dims

Strategies in HIV prevention: the A-B-C approach

Uganda Takes Up Abstinence Campaign

As noted by commentaries, many international agencies have been slow to react to the Ugandan experience, favoring instead traditional approaches that feature blood donation testing, harm reduction (i.e., promotion of condoms and avoidance of shared needles), and the increasingly dim promise of future vaginal microbicides and vaccines.

Cost-effectiveness of Screening

In United States, both public health officials and policy analysts are recognizing the importance of early HIV detection efforts, including widespread routine screening in medical care settings. Three articles on this topic appeared in February 2005 in the New England Journal of Medicine, available below. 

Commentary on routine HIV screening (RAND)

Cost-effectiveness of HIV screening (Duke)

Cost-effectiveness of HIV screening (Yale/Harvard)

Experimentation and Innovation

HIV/AIDS remains a terrible disease, but one that can be addressed. The intent of this site is to present public health strategies for developing countries that rely on knowledge of the virus, rather than idealistic or fearful visions of the disease in society.

Technical articles by Professor Frerichs and colleagues are cited in the following table, describing HIV testing with saliva, personal screening programs and community surveillance systems. 


SEA-AIDS Network


Saliva, Screening and Surveillance articles


Confronting HIV in India (SLIDE TALK)


Issues in Home HIV Testing (SLIDE TALK)


Posting 1. Theme for Fourth International Conference on AIDS in Asia and the Pacific. March 25, 1996.

Posting 2. Theme for Fourth International Conference on AIDS. March 31, 1996.

Posting 3. More discussion on early detection. April 2, 1996.


Posting 4. Thoughts on home testing. April 8, 1996.


Posting 5. Response to "three practical suggestions for Manila conference." April 18, 1996.

Posting 6. Heterosexual HIV transmission and testing.  April 24, 1996.

Posting 7. Prenatal versus Postnatal HIV Screening. May 9, 1996.

Posting 8. Premarital HIV testing in Thailand, May 16, 1996.

Posting 9. Rapid test. June 6, 1996.

Posting 10.  Response to Bennett's Posting of AIDS news. July 3, 1996.

Posting 11. Saliva and HIV Transmission, Aug. 29, 1996. 

Posting 12.  HIV and health insurance. Sept. 22, 1996.

Posting 13. HIV testing - a reply. Oct. 2, 1996.

Posting 14. Response to comment on HIV and health insurance. Oct. 9, 1996.

Posting 15. Estimates of AIDS cases in Thailand. Nov. 5, 1996.

Posting 16. HIV in Indonesia. Nov. 7, 1996.

Posting 17. HIV Epidemic among CSWs in Thailand and Indonesia. Nov. 12, 1996.

Posting 18. Normalization of HIV versus Sexworkers. Nov. 20, 1996.

Posting 19. Prison-based HIV/AIDS education programs. Jan. 23, 1997.

Posting 20. Rights of mother versus rights of child. Feb. 11, 1997.

Posting 21. HIV and needlestick injuries. March 6, 1997.

Posting 22. Testing for early detection of HIV. July 7, 1997.

Posting 23. Early screening of HIV in pregnant mothers. July 15, 1997.

Posting 24. Early HIV detection, marriage, India. Aug. 21, 1997.

Posting 25. Criteria for HIV testing in Asia. Oct. 6, 1997.

Posting 26. Pregnancy & HIV Testing. Nov. 12, 1997.

Posting 27. Routine hospital HIV testing and prophylactic AZT. Dec. 3, 1997.

Posting 28. Routine hospital HIV testing and prophylactic AZT. Dec. 6, 1997.

Posting 29. Frerichs response to routine HIV testing. Dec. 17, 1997.

Posting 30. Access to treatment... and testing. Feb. 18, 1998.

Posting 31. AZT trial results. Feb. 20, 1998.

Posting 32. Biologically-based HIV control strategies. March 30, 1998.

Posting 33. AZT/MTC underscores women's health. April 6, 1998.

Posting 34. Response to AZT/MTC - UNAIDS Meeting Statement. April 13, 1998.

Posting 35. Finding solutions to HIV in the developing world. April 24, 1998.

Posting 36. Needle exchange controversy. April 27, 1998.

Posting 37. Voluntary versus mandatory HIV testing of pregnant women. May 4, 1998.

Posting 38. More thoughts on mandatory HIV testing... May 8, 1998.

Posting 39. WHO Budget Cuts for SE Asia? May 15, 1998.

Posting 40. Experimentation and broadening the audience. May 27, 1998.

Posting 41. WHO and the World Bank. June 1, 1998.

Posting 42. Acceptance of personal HIV screening. June 10, 1998.

Posting 43. Response to Acceptance of personal HIV screening. June 13, 1998.

Posting 44. Response to Acceptance of personal HIV screening. June 15, 1998.

Posting 45. Response to Acceptance of personal HIV screening. June 19, 1998.

Posting 46. Response to Acceptance of personal HIV screening. June 25, 1998.

Posting 47. Response to Acceptance of personal HIV screening. July 11, 1998.

Posting 48. Response to Acceptance of personal HIV screening. July 22, 1998.

Posting 49. Battle-Scarred Veteran is General in Global War on AIDS. Aug. 5, 1998. 

Posting 50. Acceptance of personal HIV screening.  Aug. 6, 1998.

Posting 51. Acceptance of personal HIV screening.  Aug. 13, 1998.

Posting 52. HIV contact tracing. Sept. 23, 1998.

Posting 53. Wave of Laws Aimed at People With HIV. Oct. 5, 1998.

Posting 54. Guidelines for preventing mother-to-child HIV transmission. Oct. 14, 1998.

Posting 55. HIV numbers, surveillance and program strategies. Oct. 27, 1998.

Posting 56. UNAIDS and the Named HIV Reporting Debate in California. Oct. 29, 1998.

Posting 57. Preventing Mother-to-Child HIV Transmission in Thailand. Nov. 4, 1998.

Posting 58. Fear and HIV Testing. Nov. 12, 1998.

Posting 59. More on Preventing Mother-to-Child HIV Transmission in Thailand. Nov. 13, 1998.

Posting 60. Responding to NACO insensitive to "right to life" of children. Nov. 19, 1998.

Posting 61. Preventing Mother-to-Child HIV Transmission in Thailand, Nov. 27, 1998.

Posting 62. More thoughts on Fear and HIV Testing. Dec. 1, 1998.

Posting 63. Voices for HIV testing and normalization, Dec. 9, 1998.

Posting 64. Jonathan Mann's mantle. Jan. 12, 1999.

Posting 65. Rights and harm in India. Jan. 18, 1999.

Posting 66. Asian crisis -- HIV testing issues. Jan. 18, 1999.

Posting 67. Asian crisis - HIV testing issues. Frustrations and Conduct. Jan. 21, 1999.

Posting 68. HIV testing realities. Jan. 23, 1999.

Posting 69. HIV testing - Frustrations and Conduct [1459]. Jan. 25, 1999.

Posting 70. Empirical data on efficacy of HIV testing in behavior change. Jan. 26, 1999. 

Posting 71. Widespread testing in high prevalence countries. Jan. 27, 1999. 

Posting 72. On being drawn into the testing discussion.... Jan. 29, 1999.

Posting 73.  A middle road to successful HIV prevention? Feb. 5, 1999.

Posting 74. Future trends in addressing HIV/AIDS in Asia. April 21, 1999.

Posting 75. Control of HIV in an economically devastated country. May 31, 1999.

Posting 76. Discrimination, Stigmatization and Human Rights. July 2, 1999. 

Posting 77. Normalization of HIV. July 26, 1999.

Posting 78. Study on Breastfeeding and HIV. Aug. 27, 1999.


For more on early detection and other HIV controversies, click below.

The Lancet - A viewpoint on personal HIV screening in developing countries (1994), critical commentaries, and the author's response.

Epidemiology - A commentary on biologically appropriate policies to address HIV (1995).

Home HIV screening debate - Multiple views on how best to be informed of HIV infection (1996).

Atlanta Monthly - The AIDS Exception: Privacy vs. Public Health - article by Chandler Burr calling for change in HIV control policies (1997). 

Confidential Named HIV Reporting debate - Two views of a controversy affecting California (1999)

New focus at CDC - The US's premier public health agency recognizes the importance of early detection and wide-spread HIV testing (2001).

Unknown HIV infection (August 2001 update) 

The AIDS obstructionists (Aug, 2001 commentary)