Monday, September 26, 2011
There may be some confusion about HIV testing in Kenya at the moment because some news sources are not too careful about saying whether the 40% figure for people never tested is only for adults or whether it's for the whole population. It's likely that the figure is for adults, but it's also likely to be exaggerated. Some people are bound to test more than once and Kenyan facilities may not be able to link multiple tests by one person.
But another confusion could arise about whether people will be 'requested' to be tested every time they visit a health facility or 'required' to do so. The ThirdAge.com article above cites someone who is advocating for testing to be requested. But an article in the Nairobi Star says everyone visiting their doctor will be required to be tested, which is quite a different matter.
According to an article in AidsMap.com, the situation is actually far more serious than the above two articles would have us believe. It cites findings that only 20% or fewer HIV positive people know their status and that at least 50% have never been tested. AidsMap also reveals that HIV prevalence in Kenya has barely changed in the last 10 years, standing at about 7%, despite the level of resources going to treatment and, to a far lesser extent, prevention.
There's a more sober account of HIV testing in Kenya in The Lancet, published less than a year ago. According to this article, the plan was to have 80% of all Kenyans tested by the end of 2010. But the highest they have ever achieved is a few million people per year. And such huge scale programs are challenging, particularly in a country with crumbling health services.
The article makes it clear that there is a big difference between 'requiring' that people be tested and 'requesting' that they do so; the rights of people to choose whether to test are not guaranteed. Nor is the safety of those found to be HIV positive. Given current levels of stigma associated with HIV, it's still very dangerous to inform your partner about your status. Not only are you more likely to test first if you are a woman, you are also far more likely to be infected than your partner.
More HIV testing and then what? If there were support services for people found to be HIV positive, more testing might be a good way of ensuring that the right people get the services. But many people are tested and receivenothing. And as a result of the HIV industry's highly stigmatizing attitude towards HIV among Africans, people found to be positive are likely to be the victims of abuse, persecution and even death.
People who agree to be tested for any disease have legitimate expectations and those trying to persuade them to be tested need to address these expectations. You won't persuade people to be tested if they know that little of benefit and possibly a lot of abuse is awaiting them. So, given that HIV is not just transmitted sexually, we need to stop telling people that it is.
The message the HIV industry is giving may be dressed up in a lot of sweet words, but it sounds like this: 'this person is a HIV positive African, therefore there is an 80% probability that they were infected sexually, or else they were infected by their mother, so they are a slut or a philanderer or in some other way immoral, but we don't stigmatize them at all for that and neither should you'.
Whether HIV testing is compulsory, as one article says, or merely requested, the problem is that people will still risk victimization if they are found to be HIV positive. Stigma does not arise, as Peter Cherotich of the Kenyan Aids Control Program claims, because HIV testing has been voluntary up to now. It arises because HIV 'prevention' programs insist, falsely, that most HIV transmission in African countries is through heterosexual sex. Changing that message may not have an immediate impact on levels of stigma, which could take decades to efffect. But it's a start.