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HIV self-testing takes away stigma

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By Rudo Shoko

AS the world ramps up its efforts to combat HIV and AIDS, HIV self-testing is an important element in achieving the 90-90-90 target.
The 90-90-90 is an ambitious target to help eradicate AIDS, but other long-standing barriers to accessing comprehensive HIV testing remain significant, especially in Africa.
The 90-90-90 is a concept introduced by the United Nations (UN) programme on HIV and AIDS in 2013.
The idea is that by 2020, 90 percent of people who are HIV infected will be diagnosed, 90 percent of people who are diagnosed will be on anti-retroviral treatment, while 90 percent of those who receive anti-retroviral drugs would have the HIV virus suppressed.
Viral suppression is when a person’s viral load or the amount of virus in an HIV-positive person’s blood is reduced to an undetectable level.
The HIV self-test kits, which have been approved by the World Health Organisation (WHO), are now being used in Zimbabwe.
WHO believes HIV self-testing, or ‘home testing’ is likely to have an important place in future global HIV strategies.
HIV self-testing is a process in which an individual willing to know his/her HIV status performs a test and interprets the result by him or herself, often in private.
HIV self-test results can be accurate, as long as appropriately regulated test kits are used and the manufacturer’s instructions are carefully followed.
There are still people who worry about HIV-related stigma, those who do not see the need to know their status for one reason or the other and those who are afraid of dying of AIDS-related diseases and so ‘would rather not know’.
A health expert, who spoke on condition of anonymity, said stigma prevented individuals from getting tested for HIV, seeking medical care, disclosing diagnosis and in adhering to treatment and follow up.
“Fear of social abandonment and losing intimate partners prevents many with HIV from sharing the diagnosis with their loved ones and sexual partners,” said the health expert.
“Stigma has become a major reason HIV epidemic continues and millions of people are getting infected and dying from HIV related diseases every year.”
Research describes stigma as a degrading and debasing attitude of the society that discredits a person or a group because of an attribute (such as an illness, deformity, colour, nationality or religion).
The resulting coping behaviour of affected persons results in internalised stigma.
When stigma is associated with a medical condition or disability, it prevents individuals from seeking evaluation and treatment, disclosing the diagnosis to the people most likely to provide support and in following treatment guidelines.
While there are many illnesses such as leprosy that have been severely stigmatised in the past, it is generally agreed that HIV and AIDS is the most stigmatised condition in the history of mankind.
While society elevates the status of those receiving treatment for some conditions such as cancer or serious injuries as war veterans, those who have acquired HIV are subjected to layers-upon-layers of stigma with assumptions that these individuals are deserving of punishment for their ‘assumed behaviour that led them to get HIV’ and they are often shunned.
Self-testing could therefore be the key for the country to achieve the first 90, which seeks to ensure that all persons living with HIV know their status.
“The lack of linkage to care, counselling and the ability of individuals to test themselves accurately and interpret results remain a major challenge in the successful implementation of home service testing,” said the health expert.
However, WHO believes that by giving people the opportunity to test discreetly and conveniently, HIV self-testing may increase the uptake of HIV testing among people not reached by other HIV testing services, including many who have never taken a test.
WHO essential medicines and health products director Dr Suzanne Hill notes that the pre-qualification of this product means that countries with poor laboratory infrastructure will be able to safely increase testing capacity, thereby facilitating treatment of people living with HIV.
“The WHO pre-qualification assures the quality, safety and efficacy of priority medicines, vaccines and in vitro diagnostics bought by international procurers for low-income countries,” said Dr Hill.
Pre-qualification is attained through rigorous assessment of products and inspection activities, building national capacity for manufacture and working with regulators to register those products quickly.

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