Putting HIV Testing to the Test: Progress, Gaps and Opportunities

1. Putting HIV Testing to the Test: Progress, Gaps and Opportunities Overview and the Experience of South Africa Name M J Heywood Date and place Vienna 22 July 2010

2. Overview • The early experience of HIV Testing: • Internationally and in South Africa • Establishing a legal and human rights framework for HIV testing • Changes to the risk benefit equation • Access to ATV treatment • The policy debate: • From NVT – VCT – PITCT - HCT

3. Early experience: 1990s and early 2000s • Non voluntary HIV testing of ‘risk’ groups • HIV testing without counselling or confidentiality • HIV testing as a precursor to unfair discrimination

4. Establishing a human rights framework based in law & policy • HIV Testing only to take place on basis of: • Voluntariness • Guarantee of confidentiality • Informed consent

5. Changes to the risk/benefit equation? • Does the HIV test as a gateway to access to life-saving ARV treatment ameliorate the need for informed consent: • Routine testing or routine offer of testing? • Opt-in or opt-out? • Extent of counselling? Counselling as a barrier to testing

6. South Africa’s HIV Counselling & Testing campaign, 2010-2011 • Voluntary HIV testing of 15 million people by June 2011 through: • Encouraging voluntary take-up of available testing at health facilities • Routine offer of HIV testing to in and out patients • Linking HIV testing to care, treatment (not just HIV) & other health services

7. The rationale • Significant increase in VCT but stigma still deterring many people • Access to treatment, but most people only seeking treatment very late, CD4<100 • Possible benefits of knowledge of HIV status to HIV prevention • Strengthen health systems

8. The experience so far: The positives • Launch on April 24, 2010 • Established an infrastructure to drive the campaign (national and provincial nerve centres) • Compelled implementation of task-shifting: • Nurse initiation • Counsellor testing • Official statistics July 2010: • 1 million HIV tests • 70000+ people additional on ARVs

9. The experience so far: The negatives (general) • No monitoring of adverse events, except by TAC & some civil society organisations • Poor M&E of HIV testing and outcomes • Research showing v poor quality HCT of service & multiple breaches of HIV testing protocol • Disconnect between testing and treatment • Major budgetary issues, demonstrated in lack of funds for mass communication campaign

10. The experience so far: The negatives (human rights) • Coercive testing. • In a number of districts is that patients are being forced to undergo HIV testing. The guidelines clearly state that testing is voluntary and that patients can opt-out of being tested. However poor education has led to confusion and in many areas healthcare workers are refusing patients access to services without first undergoing an HIV test regardless of their ailments. Coercive testing has been identified in the districts of Ekurhuleni and Mopani. * • Non-residents denied services. • Non-residents are being denied access to services and especially HIV testing services. There is an understanding that the HCT campaign only extends to South African citizens. In some facilities in Mopani, patients without ID books are denied entrance into health facilities. From October 2009 to March 2010 foreign nationals living in GertSibande, Mpumalanga without IDs had their treatment interrupted. Following TAC’s intervention all facilities were instructed to provide ART to foreign nationals in South Africa. * • (Source: Treatment Action Campaign, Assessment of Implementation of HCT Campaign in Six Health Districts in SA)

11. Conclusions: • HCT a necessary and justifiable campaign, but: • If ends (access to treatment & other health services) not being met • Means (mass HIV testing) cannot be justified • Requirement for better M&E, communication

12. For further information visit: www.section27.org.zawww.tac.org.za