Re: Feasibility of International HIV Testing day

[Guest guest]

Dear FORUM,

Re: Feasibility of International HIV Testing day

Observing an International HIV testing day is a good idea provided the following

pre conditions are satisfied.

The day should come at the end of a week of HIV/AIDS awareness wherein public

education programmes regarding the basics of HIV/AIDS, including treatment

options, care and support system if tested postive should be arranged.

There should be enough testing facilities.

Facilties for the care of those tested postive should be ensured.

Incentives for those who come forward for testing should be provided ( as we did

for familty planning campaign)

Celebrities like Ministers, Film Stars, Cultural leaders should take the lead in

testing

Ekbal

E-MAIL: <ekbal@...>

[Guest guest]

Dear FORUM:

As regards the feasibility of Int'l HIV Testing Day, may I submit that our own

VCCTC Centers at district headquarters should declare a weeklong program with

2nd December itself to serve as the INTERNATIONAL HIV TESTING DAY as the 1st Dec

could be used to motivate people just like Pulse Polio Program.

The 2nd of every December be observed for this purpose. The entire week 1st

through 7th can be observed as HIV-Week to weaken the stranglehold of this

deadly infection.

Just like the Pulse Polio celebrities could be roped in to motivate the masses

and contribute out of their income just 1 percent each person a year, This way

we can go a long way to help the masses in dire need for the right kind of

education, counseling and testing.

I hope this can be possible and feasible logistically as our VCTCs are already

supposed to do the same. Often they under perform and reportedly sell the kits

in open market.

Dr S TARIQ WALI

ANGELZ [iNDIA] TRUST

1-5 UNIQUE PALACE, CIVIL LINES

ANOOPSHAHAR ROAD, ALIGARH-202002

UP, INDIA

URL: Http://www.angelzindiatrust.org

Ph: +91-5713206223

e-mail: <drstwali@...>

[Guest guest]

Dear FORUM,

Observing days for a specific cause always helps to draw attention to the issue

and in the case of issues like HIV/AIDS it has helped to increase awareness and

reduce stigma. In the same light one can assume that HIV Testing Day may help

people know more about

testing and may also normalise HIV testing. Having said this, it should also be

understood that the proposal is not without shortcomings and questions.

We must ask whether those who would get tested for HIV on a " Testing Day " will

really be those individuals who are into high-risk behaviour? The possibility is

very low. Such days are highly symbolic in nature and in the spirit of symbolism

many people who are very confident about not being HIV+ve will volunteer to get

tested. Thus swelling the number of people who get tested at a particular

testing site. But those who are really into high risk behaviour and aware of it

would refrain from doing so. It has been observed that those who see themselves

as potentially HIV+ve do not go for HIV testing unless they are mentally

prepared for it.

In the whole bargain a huge amount money will be spent on physical arrangements,

personnel, publicity to organise " testing days " where the actual people who get

tested would be mostly those not involved in high-risk behaviour.

Counselling is the second most important factor. Will we be able to provide

quality counselling on such days? It will be very difficult at an emotional

level, for a person to find out that he/she is HIV+ve on an International

Testing Day when everybody around is in

a mood to get as many people tested. The quality of Pre and Post Test

Counselling cannot be ensured on such days which assume almost a festive

character.

Especially in countries like India where the past experience has shown that

projects such as these (for example, Family Planning Operation Camps) are driven

by the targets, the possibility of this could be very high. HIV testing is

futile unless the person is fully

made aware of what are the implications of being HIV+ve. One must never forget

that being HIV+ve does require several lifestyle changes which are not easy to

bring about unless reinforced and encouraged by continuous counselling. If such

counselling is not

undertaken it can actually lead to a tremendous psychological pressure on the

person.

It is time that we admit that we have failed to make ARTs available to most of

the people living with HIV/AIDS even after many promises and at times sincere

efforts by several agencies if one may like to call it so. Countries like India

will still have to put in a lot of work to create infrastructure and personnel

who can deliver ART efficiently in the remote areas of the country. If we do

find a large number of people to be HIV+ve, during testing days, what services

will we be able to provide them besides helping them control

secondary infections?

These are the some of the questions one may have to look at very carefully and

have concrete answers to them rather than the usual hogwash.

One the whole, one can say that having an International Testing Day may help in

educating people about HIV testing and reduce stigma related to testing. But it

may not be able to achieve reaching

out to people who could be HIV +ve, if that is the objective of the whole

exercise.

Shailesh Vaite

shaileshvaite@...

Phone- 09821224191

[Guest guest]

Dear FORUM,

I agree to what Shailesh has written in his mail. I wanted to add a few things

so that we all can think about the feasibility of International HIV Testing day.

The idea of having a HIV Testing day is good. For me its altogether on a

different plane and not like the AIDS awareness day or week we observe. There is

confusion in our minds about the way in which this day will be observed. Should

it be for making people aware about the testing facilities available around them

(a logical step after making one aware of the routes of transmission, signs and

symproms etc. Also many a times people go to private set up thinking the quality

of HIV testing service to be bad, as it is located in the public setup). Or

should there be makeshift testing centers to be opend on the day and testing

done. Well I do not subscribe to the later as it will result in chaos which my

friend has raised in his write up.

What appeals to me is that one part of the day might be actual testings being

done at the existing VCTC. The other being awareness about testing at various

locations. But for sure a large chunck of testings will follow after the

observence of the day. It defenitely should not be target based " day " but there

has to be a larger bench mark for the whole year (As the Family Health Awareness

Week observed twice a year to promote STI treatment seeking behavior).

By doing this we increase the utilization of the VCTC service which are better

than many of the private lab set ups where there is no pre and post counseling

and HIV test is done as a routine blood test. The psychological pressure is more

in the later than former.

Its high time that we come out of this " high risk behaviour " group mentality.

The issue of HIV and AIDS is not restricted to a specific group but is a matter

of concern for the whole general population and development of the nation too.

There are many interventions for the " high risk groups " working on behaviour

change and resulting in utilization of the VCTC services.

What we have to worry is that from the general population only the ANC is the

lot getting tested for HIV. Such a day can bring in a lot of other segments of

the general population in to the picture.

With regards to the availiblity of services and facilities like the ARTs, its

altogether a different issue to be addressed at different level.

My suggestion is that the VCTCs should be open on Sundays and other holidays for

peoples convenience and also such a marker day to be observed on a specific

Sunday of a particular month.

Dr. Athar Qureshi

e-mail: <qathar@...>

Tel 0-9839911571

[Guest guest]

Dear Forum,

The High Risk Behaviour bogey raised by the fellow member is trite and outdated.

As Dr Qureshi says the earlier we got rid of this mentality the better it would

be for all of us. HIV transmission respects no behavioural characterstics- a low

or no risk behiour may entail HIV infection. Like MTCT, improperly screened

blood transfusions,occupational exposure to healthcare professionals and so on.

That one day- say 2nd December every year- be earmarked as International HIV

Testing Day with free HIV Screening and counselling. Ist December to be

earmarked for HIV/AIDS AWARENESS CAMPAIGN on the World AIDS Day. Next five days

could be utilized to documentation, source of HIV in HIV+ detected on the 2nd

December and for other related work at the district headquarters. Pulse Polio

Campaigns provide a good example to manage the HIV Testing Day. The very first

day is Booth Day the next days are utilized for door-to-door campaign and

coverage of x-marked homes.

Dr Qureshi has supported the under-utilization of VCTC resources. And here is

the key to the feasibility of the entire program that I have humbly suggested.

Logistically, counselling is provided to those who come to the VCTCs. If we have

got sufficient kits available, it is fine. Next five days could always be

utilized for intense individal counselling also. The donors of the program will

see to it whether the kits are sufficient, trained manpower at VCTC, volunteers,

and so on. The hasty approch is not helpful nor is the target-oriented approach.

We can implement this program from next year in certain districts and in the

coming two years, universal coverage could be ensured at least in India. The

gestation period is somewhat 3-4 years. We could very well have this

International HIV Testing Day-2nd December to be observed universally from 2010

onwards and in certain high prevalence states from 2007/8 onwards.

This program could be run under RURAL HEALTH MISSION also as the funds are

aplenty and its penetration is good.

Dr S T WALI

Chairman

Board of Trustees

ANGELZ [iNDIA] TRUST

1-5 UNIQUE PALACE

Opp Sir Sulaimann Hall

Civil Lines

ALIGARH-202002

Ph 05713206223

Http://www.angelzindiatrust.org

E-mail: <drstwali@...>

[Guest guest]

Dear Forum,

Why is HIV testing by itself being promoted as though it is prevention tool?

What are we expetced to achieve? Do we want more and more people to test? If so

who do we want to go in for testing? And what happens to those who undergo the

test and test positive? What support is in place for them?

We must understand that HIV prevention and control is very different from the

polio eradication program. And we cannot follow similar strategies. In case of

the polio eradication program, a child getting the vaccine is the expected

outcome, which is a one- time

activity. In case of HIV prevention, HIV testing is only one step towards a

larger outcome expected- sustained life- long behavior change. Since the

expected outcomes are so different, it follows that we need to use different

strategies.

One of the biggest challenges of the HIV epidemic has been stigma and

discrimination. And in the US it was when Magic disclosed his HIV status

that there was a surge in HIV testing and care- seeking. And this is seen to

have contributed greatly to reducing HIV- related stigma.

But in India, even if we do have an HIV testing day, it is doubtful if any of

the public icons -be they sportspersons, film stars, politicians-would come

forward to testing or disclose their result. And would those who need to test

really come on such a day?

May be the resources would be put to better use if we focus more on better

quality HIV counseling, reducing HIV- related stigma and discrimination and

developing mehcanisms for adequate referral and networking among organizations

working on HIV/ AIDS issues.

Akhila Panchamukhi

e-mail<akhila_punch@...>

[Guest guest]

Dear Forum,

I could not agree more, (with the posting of Akhila Panchamukhi)and would like

to add that the people advocating such a testing day do not know a lot about HIV

or it's prevention or about behaviour change.

Not only do we need to think about what can be done for people who test

positive, but what about the people who test negative, will they receive

counselling to help them to stay negative or be advised about the window period

and be encouraged to come back for a second test?

Cheryl

Team Leader

National HIV and AIDS Support Project,

Papua New Guinea

e-mail: <ckelly77@...>

[Guest guest]

Feasibility of International HIV Testing day.

On Tuesday night, I happened to hear Anjali Gopalan loud in an NDTV

show, that corporate philanthropy is biased of profit and the

concept of Giving is forsaken. I wish she should have added that

the corporate philanthropy and bilateral funding patterns are even

taking the concept of voluntarism away from the mindset of people.

However, accepting the profit doctrine as today's mantra, I wish to

seek opinion of the learned members of the forum on Care, Support,

Treatment and its benefit to the nations HIV prevention efforts.

I assume that every one will agree in principle that Care, Support

and Treatment will contribute to the national effort to halt and

reverse the HIV epidemic. But, there is little evidence in support

that the fund allocations are translating this with conviction.

Though there is a commitment by the Government to provide ART to all

those who are eligible for it, there is still hesitation in scaling

up, may be for the fear that it will not match up with the

prevention efforts.

All of us are aware that the distance between WHO estimation of

770,000 people in need of ART in 2004 and NACO's target to provide

ARV for 30,000 by people in 2006 and 200,000 people by 2011 is

excessively behind.

If I am not wrong, there are assumptions that ART centers may not be

able to achieve the targets, if targets are scaled up. As on 31st

March 37368 people are on ART. There is no data in public domain to

check the current situation of demand for ARV in various centers.

Even if we go with the argument that there is no demand (Which is

not true), is it not a failure on our part to inform the public that

ARV is available? Why should we limit our communications strategy

for ART program to inter-personal communication? How can we inform

the public through any media about ARV and Care and Support services

when adequate provisions are not made for it?

In short, the scenario indicates that the contribution of care,

support and treatment, in preventing the spread of HIV is undermined

with out adequate attention.

There are millions in India, who do not know their HIV status and

spread the infection to their contacts. Do we have a presentable

data on the actual number of people who got tested positive in

India? If it is available how big, is the difference between the

extrapolated 5.2 million?

I have come across people telling, why should we get tested when

there is no cure. The message that HIV is an incurable, killing

disease has gone across to people who have access to media, but

nothing is shared about life after HIV infection. What are the

incentives offered for people to be tested when there are so many

pulling factors that drive them away from the VCTC's.

In the context of the discussion on feasibility of International HIV

Testing Day, I will reiterate that Access to Treatment, Care and

Support and Treatment Education will prove the most fruitful

incentive for people to access VCTC services.

It is very important to educate the people, what are the benefits in

knowing the status early. This education is inseparable from

treatment awareness. International HIV Testing Day can become a

campaign for treatment awareness and promotion of Positive

Prevention.

Regards

E-MAIL: <awaazdho@...>

[Guest guest]

Dear All,

I obsolutely agree with , As VCTC is an entry point for PLHAs it is

the most important moment a counselors can impart information on treatment

available for HIV. VCTC counselors play a vital role in the life of PLHAs, as

when a person tested positive its totally a new begining the person whom they

first meet was the counselor.

Their is alot of IEC meterials available on HIV/AIDS awareness, so far atleast

people are aware of HIV/AIDS and know how to prevent , BUT most of the PLHAs

don't where to access treatment ,they don't where ART

centre are located. Hand in hand where we advocate for testing we should'nt

forget where Care & support services are available if they tested positive.

Mike Tonsing

Delhi Network of Positive People

e-mail <dnpplus@...>

[Guest guest]

Dear FORUM:

Feasibility of International HIV Testing day.

The Forum initiated the discussion on feasibility of observing

International HIV Testing Day, to which several distinguished respondents sent

in their responses so far.

I have very modestly mooted the idea that our own VCTCs are hopefully capable of

handling the load as they are presently under performing and given the added

support obviously to be lent to them in view of the International HIV Testing

Day, we have no reasons to be unduly pessimistic in this regard. We can very

well manage them to deliver results.

Secondly, I sought to project an outline for the weeklong HIV Testing Week [1-7

December every year] I proposed with the first day of the Week to be reserved

as World AIDS Day when we can very well organize programs to bolster up mass

consciousness by holding road shows, rallies, seminars, street corner meetings

and so on just like we do preceding the Pulse Polio Sundays for Pulse Polio

Immunization Campaign.

The next day [2nd December every year] could be marked as International HIV

Testing Day when our PHCs/CHCs/District Hospitals and VCTCs could be roped in to

offer Free HIV Testing and requisite mandatory counseling. The next five days

could be utilized to organize post-test counseling, documentation, and also to

offer HIV Testing for the left out lot and also to those who might have passed

on the HIV infection to those testing positive after taking due care following

an interview-based search of the index case.

The idea is, among other things, to augment the outreach for improved level of

HIV screening. Modalities of these micro-plans could be sorted out locally,

nationally and globally.

I also suggested that Rural Health Mission could play a key role in holding this

mega event of HIV Testing Week to weaken and eliminate the stranglehold of

HIV/AIDS.

Now, one respondent chose to question the entire premise of testing on the

ground that we have insufficient resources for supplying ART to those found

HIV+. It boils down to the basic poser: Why should we organize the screening

test program at all if cannot treat the person found HIV+!!

I cannot foresee a day when we will be sufficiently armed with the ART to take

care of all HIV+ persons whether we stop testing for HIV today! The objection

seems to have come from the apprehension that the number of HIV+ people are

bound to swell once we test the larger cross section of the populace. If we have

the mismatch this is a separate issue concerning treatment part. What is

emphasized here is screening and diagnostic outreaches, which will ipso facto,

cause a far greater amount of mass awareness.

Besides, there shall always be a gap between available and optimal levels of

counseling as well as availability of ART. On the basis of this fallacious

reasoning, we cannot indefinitely postpone the case detection component the key

to the HIV Prevention Programs world over. Mixing up issues will not help us a

bit.

The Pulse Polio Campaign that I chose to illustrate my point was even utilized

to teach me [!] that Polio and HIV are different and that vaccine is unavailable

for the latter. That didactic comment was unusually amusing for a person like me

who is a post grad in Pediatrics!

Professor , the doyen of our own Pulse Polio Campaign has very kindly

intervened, lent his kind support, and stated,“ it is very important to educate

the people, what are the benefits in knowing the status early. This education is

inseparable from treatment awareness. International HIV Testing Day can become a

campaign for treatment awareness and promotion of Positive Prevention.”

Professor ’s wise counsel must not be overlooked and I would like to quote

him, “There are millions in India, who do not know their HIV status and spread

the infection to their contacts. Do we have a presentable data on the actual

number of people who got tested positive in India? If it is available how big,

is the difference between the extrapolated 5.2 million?”

May I reiterate that my response to the Forum was focused strictly on the

feasibility or otherwise of the HIV Testing Day… Other related issues call for a

separate debate and must not be brought in to confuse and obfuscate the issue at

hand.

Dr TARIQ WALI

ANGELZ [iNDIA] TRUST

1-5,UNIQUE PALACE

CIVIL LINES, ANOOPSHAHAR ROAD

ALIGARH-202002, UP, INDIA

URL: Http://www.angelzindiatrust.org

Ph: +91-5713206223

e-mail: <drstwali@...>

[Guest guest]

Dear forum,

I agree with what Prof Ekbal said about involving celebrities. Mass

media campaigns announcing the date and increasing towards the said date must be

completed. Campaigns that people of all walks of life must think about testing.

We must also break this myth that only economically weaker sections

of our community are HIV positive.

Campaigns that anyone maybe HIV positive and if you test positive

there are services available must be emphasised.

However In our effort to get many people to test, we must not forget

to provide quality and confidential counselling and testing. Confidential out -

referrals in case of those who are positive must be ensured. Assuring

confidentiality and campaigning against stigma and discrimination must both go

hand in hand.

Magdalene

Magdalene Jeyarathnam

Counselling Consultant

Tamil Nadu State AIDS Control Society

e-mail: <magdalene.jeyarathnam@...>

[Guest guest]

Re: Feasibility of International HIV testing day

Dear forum,

There can be no question that the organization of an International

HIV testing Day will aid in promotion of testing and in HIV

prevention. In India, only a small percentage (perhaps only less

than 10%) of the 5.2 million estimated to be HIV infected knows

their HIV status. Not knowing their HIV status hinders people from

seeking care and also from spreading the infection to others.

Currently, there is no imaginative campaign on self risk assessment

and testing. Although a large number of VCTCs have been established

throughout the country, attendance is poor. If a well designed

testing campaign is conducted, there is no doubt that more at risk

people will volunteer for testing. But, if we want to expand

counseling and testing on a large scale, we also have to take

counseling and testing facilities to their door steps; through

outreach counseling facilities employing NGOs and arranging for

transporting blood samples for testing at a VCTC. Easy availability

of counseling and testing will result in far more uptake. It is

essential to have a good promotional campaign which presents

counseling and testing in an acceptable manner.

The counseling, testing and related services have to be of good

quality. The testing centres should have good linkages with

NGOs/hospitals/ART centres etc, so that the beneficiaries can access

their services, when required. A testing campaign spread over a

fortnight or a month even, would be much better than token testing

for a day. It would have greater effect, if done along with the

world AIDS day activities.

Dr. M. Prasanna Kumar

e-mail: <mpkumar@...>

[Guest guest]

Dear FORUM,

Re: Feasibility of International HIV Testing day. We have to relook at our goal

/ aim. What is it that we want to do about HIV/AIDS?

And then look at the ACTION plans. Where will HIV/AIDS testing take us on tha

path to that goal.

And even if both of them fit well we must not forget that sometimes we set our

goals completely wrong and therefore enjd up being on the path we should never

have been on.

That is why 'one must keep questioning even one's own assumptions, beliefs' (not

my thought but Galileo's).

AIDS/HIV is unfortunately has not remianed a mere infection of the body.

Unfortunately, the social stigma takes a needless toll on people affected with

it. That perhaps is the bigger problem today, for death is inescapable but

social discrimination sure

is, if we can stand against it.

Mere testing of HIV/AIDS to identify positive people may actually not be of much

use. Unless we have set other things right.

Dr. Parvez Imam

Director

f-20 Communications

e-mail: <drparvezimam@...>

[Guest guest]

Dear FORUM,

I believe that we should not test people for any disease if we cannot

give them treatment, same applies to HIV also.

Look at other communicable diseases ; we had Effective , Universal ,

Free or Affordable treatment for LEPROSY, TB [ MDT & DOTS ] and with

this HOPE in mind people came out voluntarily seeking COUNSELLING and

TESTING.

Without any Hope why should 'one 'come for TESTING and if

found 'positive' to be OSTRACISED and STIGMATISED by all and sundry.

As long as we cannot provide Aproppriate treatment at all Health posts

[free of charge] under NACO we should not go on testing people

indiscriminately and brand them.

It is for this that I am not sure if the International Testing day

will do justice

mathews m

e-mail: <docmathews@...>

[Guest guest]

Dear Forum,

Though it sounds excellent to have such a day been observed internationally, one

needs to take some of the following issues also into account while actually

going head with such an idea:

1. If the day is been declared due to x,y,z reasons and

pressures, how objectively will programmes and policy makers in different

countries be able to implement the same without hindering other aspects of

testing like maintaining confidentiality and anonymity of patients, in that case

one has to think alternatives for the abbreviation VCCTC?

2. How are programmes and governments going to garner infrastructure, manpower

and money for the same

3. How is programme going to face the uphill task of providing care

and support to people who turn out to be positive, if the ethics dimension is

added to the same.

4. What about prevention and awareness building amongst population

who are found positive how are programmes going to handle those.

And a lot many such major and minor issues which need to be

addressed first, rather than putting across a day for testing, foresight

regarding such issues which will further complicate things if different regions

and countries due to lack of adequate infrastructure and trained personnel needs

to be the top priority for the programme and policy makers internationally,

nationally and

locally.

SAJU JOSEPH

Research Supervisor,

MAAS-CHRD,

Aundh, Pune - 411007.

e-mail: <saju_333@...>

[Guest guest]

Dear Forum

How many of the NGO staff working in either prevention or care have gone for

testing. Why shouldn't they speak about it. A group which is more knowledgable

and expereince

Dr.Manorama

e-mail: <pmanorama@...>