HIV, AIDS and sexually transmitted infections - care, support and prevention - AIDS action  

HIV, AIDS and sexually transmitted infections - care, support and prevention - AIDS action

  HIV / AIDS and sexually transmitted infections
  care, support and prevention

 

• Home • Site Map • About Us •



Connect

Follow MotherChild on Twitter  Connect with MotherChild on Facebook  Subscribe to HealthPhone on YouTube


AIDS action
Caring with confidence
HIV and safe motherhood
HIV testing
Making Sex Work Safe
Men's sexual health matters
Steps to making sex safer
HIV/AIDS Resource Pack
 


 HIV, AIDS and sexually transmitted infections - care, support and prevention - AIDS action
 

Practical information for health
workers, educators and community
carers on HIV, AIDS and sexually
transmitted infections covering care,
support and prevention.

Source International Information Support Centre
International Information
Support Centre



HealthPhone: Health, Medical Training Videos



 

 
HIV testing: a practical approach  >  Section 1: Why test for HIV? 
This section as pdf  1.97 mbThis section in pdf format


Section 1: Why test for HIV?

HIV testing: a practical approach

Acknowledgements
Definitions
Introduction
Why test for HIV?
Deciding which tests to use
Screening blood for transfusion
Implementing HIV testing for individuals
Screening for surveillance
Appendix 1
Appendix 2
Resources
Organisations
Questionnaire

 

bullet

1.1  When are HIV tests used?

bullet

1.2  Questions to consider before implementing HIV testing

bullet

1.3  What are the advantages of voluntary HIV testing?

bullet

1.4  What are the disadvantages of voluntary HIV testing?

bullet

1.5  What problems are associated with mandatory testing?

 

 

 

HIV testing: a practical approach    5   Page 6   7  top of page

  Section 1: Why test for HIV?

 


HIV testing is essential to ensure a safe blood supply. In Zimbabwe, high school students are encouraged to donate blood.


HIV testing is essential to ensure a safe blood supply. In Zimbabwe, high school students are encouraged to donate blood.

This section looks at when HIV tests are used, possible reasons for HIV testing and the advantages and disadvantages of HIV testing.

1.1  When are HIV tests used?

An HIV test detects the presence of the HIV virus itself or antibodies to the virus, in blood, saliva or urine. HIV tests are used for screening blood or organs, diagnosing HIV infection in individuals, or conducting surveillance or research.

Screening blood or organs 
Donated blood and organs are screened before transfusion or transplant to prevent transmission of HIV to recipients via infected blood or organs. Screening (testing all) donated blood to ensure that it is safe for transfusion accounts for most HIV tests performed worldwide. Screening programmes have helped to reduce the transmission of HIV through untested, infected blood, and are widely agreed to be a cost-effective HIV prevention strategy.

For blood transfusion programmes, the primary concern is the provision of safe blood. However, it is essential that potential donors know that their blood will be tested for HIV, and that they will be informed of their results if they are positive. When blood or organ donors test HIV positive, it is essential that they are offered appropriate counselling and referred to ongoing care and support systems, and that their results are confidential.

Diagnosing HIV infection in individuals 
HIV testing is used to confirm whether a person has HIV infection, usually for people who are asymptomatic (have no symptoms). More than one HIV test is required to diagnose HIV, and a combination of different tests is used. Programmes that are providing HIV testing to individuals must be aware of the possibility that a person may test HIV negative because they are in the window period (they have recently acquired HIV but their body is not yet producing enough antibodies to be detectable by an HIV antibody test, see Section 2.1). 

It is not usually necessary to test for HIV to treat a person who is sick. The treatment for the illness is almost always the same regardless of HIV status.

Conducting surveillance or research 
Surveillance and research involves testing specific groups of people to find out the incidence of HIV (the number of cases of HIV infection) or to estimate the prevalence (percentage of a population infected with HIV). Surveillance uses anonymous unlinked testing, ensuring that the results cannot be linked to the individuals whose blood has been tested.

    

 

 

HIV testing: a practical approach    6   Page 7   8  top of page

  Section 1: Why test for HIV?

1.2  Questions to consider before implementing HIV testing 

Surveillance has relatively few implications for the people who are tested, because it is usually unlinked and anonymous. However, HIV testing has many implications for the people being tested, in both blood transfusion and individual testing programmes.  
 

Questions to help decide whether to test an individual for HIV.

Before introducing HIV testing programmes, the following questions need to be considered:
 

bullet

Who is promoting testing and why?

bullet

Who will be offered testing?

bullet

How will this benefit them?

bullet

Will the benefits outweigh the possible disadvantages for the people being tested, and for others? 

bullet

Is there a demand for counselling and testing services?

bullet

Will further testing to confirm all initial positive results be available?

bullet

Will testing be part of a comprehensive programme offering counselling, education, care and support?

bullet

What are community attitudes towards people with HIV and AIDS, and is there community support for HIV-positive people?

bullet

Is HIV testing the best use of the resources available for HIV prevention?



Where HIV testing may have benefits, the next step is to ask whether testing can be provided in a way that includes the following essential requirements:
 

bullet

pre-test and post-test counselling

bullet

informed consent

bullet

confidentiality

bullet

supervision and quality control

bullet

follow up care and support for people with HIV.


Mandatory testing carries no benefits, either in supporting people who have HIV or in preventing further HIV transmission. The problems associated with mandatory testing are discussed in Section 1.5.


    

 

 

HIV testing: a practical approach    7   Page 8   9  top of page

  Section 1: Why test for HIV?

1.3 What are the advantages of voluntary HIV testing? 

HIV testing can have benefits for the person who takes a test, their sexual partners and the wider community, provided that it is part of a package of prevention, counselling, care and support. It can lead to improved health and medical treatment, more informed decision-making, better practical and emotional support, increased motivation to prevent HIV transmission, and more positive attitudes towards living with HIV. 

Improved health and medical treatment 
Voluntary counselling and testing is an important starting point for access to prevention and care (see diagram below). People who take an HIV test may be more motivated to reduce the risk of HIV transmission for themselves and others. 

Prompt and effective treatment of opportunistic infections (common infections in people whose immune system is damaged, that do not usually affect people with a healthy immune system) can help people with HIV to stay well. People who know that they have HIV infection can seek early medical care for health problems and obtain advice about good nutrition and how to look after themselves. HIV-positive people with tuberculosis infection, that has not yet progressed to active tuberculosis (TB), can benefit from treatment to prevent them developing TB disease (see page 32). In some places, people with HIV may have access to antiretroviral therapy (treatment with drugs that affect the HIV virus itself).

However, the benefits of testing depend on the availability of care to support the person. There is no advantage in knowing HIV status in places where treatment available is no different for people with or without HIV infection, or where there is no advice and support for people with HIV.
 

From testing to care 

It is important that HIV testing services are linked to care services. The Friends for Life Centre in Thailand was set up by Buddhist monks who saw that many people with HIV had nowhere to go and no money for treatment.

After being diagnosed with HIV at hospital, people are often afraid to admit that they have HIV to their relatives, for fear of being a burden to them or being rejected. A centre staff member first talks to the person to identify his or her needs.

The centre encourages the person to talk to their relatives and supports the person to talk to their relatives and supports the person and their family to live healthily at home. Carers are taught basic skills like identifying symptoms of common opportunistic infections and providing care. Herbal medicine is often used to relieve symptoms. The emphasis is on living healthily - both physically and spiritually.


Informed decision-making 
There is a risk of HIV transmission from a mother with HIV to her baby during pregnancy, birth or breastfeeding. If men and women know their HIV status, they can make more informed decisions about their sexual lives, whether to have children and how to feed their babies. In some places, pregnant women who know that they have HIV may have access to antiretroviral therapy and alternatives to breastfeeding, which can reduce the risk of mother-to-child HIV transmission.

 

Ensuring a continuum of care for people with HIV



    

 

 

HIV testing: a practical approach    8   Page 9  10  top of page

  Section 1: Why test for HIV?

 

Practical and emotional support 
People who have been worried about HIV may benefit from learning their HIV status, if they have access to follow-up support from counsellors, their family and other people living with HIV. Well-trained counsellors can provide emotional and psychological support to help people to cope and to live positively with HIV. They can refer them to support groups and other forms of practical assistance, and they can help them to plan for the future.

Prevention of HIV transmission 
People who know that they have HIV can take steps to protect themselves and sexual partners who may be uninfected. People who test negative can be counselled about how to avoid HIV infection. There is some evidence that HIV counselling and testing programmes can motivate people to change to safer sexual behaviour, if testing is voluntary and accompanied by high-quality post-test counselling, provision of condoms and ongoing care and support.

Living positively 
Where HIV testing is part of a comprehensive programme of counselling, education, support and care, people with HIV can be helped to live positively Such programmes are only likely to be effective if communities already have open attitudes towards people with HIV. Awareness-raising activities are needed to enable communities to understand about living positively with HIV, and to dispel myths about transmission through casual contact.

 

How voluntary counselling and testing can help 

There is little evidence that HIV testing alone, or in combination with counselling, leads to behaviour change. But HIV counselling and testing can have wider benefits as part of a more comprehensive programme of prevention and care.

The Tanga AIDS Working Group offers voluntary counselling and testing at centres in three towns in the Tanga district of Tanzania. The centres have found that knowledge of HIV status, combined with post-test counselling provided by trained counsellors, and easy access to condoms and information about condoms, has encouraged people to take better care of their health.

People have reported fewer illnesses and a significant increase in use of home care, folk healers and medical services. They are more likely to seek care for sexually transmitted infections and simple illnesses that are easily treated, such as diarrhoea, rashes and headaches. The number of couples practising family planning has also increased from 20  per cent to almost 50 per cent, mainly as a result of increased condom use. These results have convinced health workers that counselling and testing is worthwhile, and they are now actively referring clients to the centres.

In Uganda, the AIDS Information and Counselling Centre found that clients reported increases in condom use from 10 percent to 89 per cent with regular partners and from 28 per cent to 100 per cent with casual partners. A recent study in Tanzania, Kenya and Trinidad found that rates of condom use or number of sexual partners were associated with knowledge of HIV-positive status, high quality counselling and provision of condoms.

The Kara Counselling Centre in Zambia found that some people changed their behaviour following voluntary counselling and testing, although the changes in behaviour did not always last long.

Similarly, in Tanzania, people diagnosed with HIV, who received post-test counselling and continuing support from counsellors, reported fewer sexual partners and increased condom use. However, after the first three to six months, condom use declined.

1.4  What are the disadvantages of voluntary HIV testing?

Having an HIV test and finding out one's HIV status can have considerable disadvantages for the person concerned. These disadvantages include problems with coping, stigma, rejection and discrimination, and human rights abuses. 

Problems with coping 
A positive test result can come as a great shock and be very difficult for a person to cope with. There is often a big difference between knowing a test result and accepting the result. Denial is a common reaction. Some people continue to deny their HIV status even when they are near death. People diagnosed with HIV also experience anxiety, depression, fear, stress and suicidal feelings. Counselling can help a person to accept their test result and to cope with their concerns. 

Stigma, rejection and discrimination 
In many places, people are very afraid of HIV. HIV-positive people have been rejected by their family or community and have experienced discrimination or violence. This is why confidentiality is so important. Media coverage about the fact that local people have HIV can lead to calls for widespread testing, without considering people's needs for care and support. Little work has been done to address community fears and reactions, and to ensure that people who disclose their positive HIV status are accepted. 

Women with HIV are particularly vulnerable. Some women have lost their homes and children, or have been beaten and abused when their HIV status has become known. Under some religious laws, a woman who has HIV can be divorced and lose her property. Partners and children of people with HIV, who may not be infected themselves, also face stigma and discrimination. 

    

 

 

HIV testing: a practical approach    9   Page 10  11  top of page

  Section 1: Why test for HIV?

 

Human rights abuses 
HIV testing can result in human rights violations. Testing should never be used to single out particular groups, especially those who are already discriminated against either socially or by law, such as sex workers, men who have sex with men and injecting drug users. 

Awareness-raising activities enable communities to live positively with HIV. In Uganda, HIV-positive women speak openly in the market place.

Despite the fact that health workers are ethically and legally bound to keep patient information confidential, confidentiality is not always observed.

Failing to observe confidentiality is an abuse of human rights and can result in other human rights violations, such as dismissal from employment or denial of health care.

  

When confidentiality is not observed 

In 1995 Jeremiah became ill and was admitted to hospital. After returning to work as a gardener his employer offered to take him to a private clinic where he would get better treatment. At the clinic he was given a blood test. No counselling was given. He was not told he would be tested for HIV, and he did not give informed consent. Soon afterwards his employer dismissed him. He was taken back to the clinic, where he was told that he was HIV positive. His employer then informed Jeremiah's wife's employer that Jeremiah had been dismissed because he had AIDS, and she was also fired.



Inaccurate test results 
One of the biggest problems with HIV testing is the window period (the time between a person being infected with HIV and their body producing enough antibodies for a test to detect). A negative test result could mean that a person has only recently been infected with HIV. A positive test result is sometimes a 'false positive' which leads the person to believe that they have HIV, when in fact they do not. A negative test result could be a 'false negative' which would mean that the person believes that they do not have HIV, when in fact they do. (For more information on understanding about the accuracy of test results, see Section 2.3, pages 11-12).

Cost of testing 
HIV testing is extremely expensive. It places a strain on health budgets in places with limited resources. The benefits of testing, except for blood transfusion services, where it is essential, need to be carefully considered. In one hospital in Uganda, for example, patients are not tested for HIV, because most people who come to hospital have HIV-related diseases. Also, despite having sufficient trained counsellors, the hospital does not have enough money to cover the cost of testing kits, and the supply is unreliable.

    

 

 

HIV testing: a practical approach    10  Page 11  12  top of page

  Section 1: Why test for HIV?

1.5 What problems are associated with mandatory testing?

Compulsory workplace HIV testing is a human rights abuse.


Mandatory testing is when people are tested for HIV without having any choice, or when it is difficult for them to refuse to be tested. Mandatory testing has been applied to sex workers, military recruits, drug users, migrants, refugees, international travellers, students and scholarship recipients, pregnant women; patients in health facilities, people being treated for sexually transmitted infections (STIs), people planning to marry, visa applicants and job applicants. The reason that is often given for mandatory testing of certain groups, or in certain situations, is that it will protect the wider community from HIV. However, mandatory testing has serious disadvantages, both for the people who are tested and for the wider community. 

 

bullet

Mandatory testing of a particular group will not ensure that members of the group are or will remain 'HIV free', because it does not detect HIV in people who have recently acquired HIV or who acquire HIV after being tested.

bullet

Mandatory testing may prevent people from seeking medical care, advice and counselling, if they fear that this will require being tested against their will.

bullet

Testing without informed consent and counselling also reduces the likelihood that a person will change risky behaviours to prevent HIV transmission to others.

bullet

Testing without informed consent and counselling can be devastating. There are many reports of people who had no idea that they were being tested committing suicide after finding out that they were HIV positive.

bullet

Mandatory testing may create a false sense of security. For example, health workers may not follow infection control procedures if all patients are tested for HIV, and clients of sex workers may not see the need to use condoms if sex workers are tested for HIV

 

In some places, fears about HIV and mandatory testing have resulted in unscrupulous doctors selling people certificates stating that they are HIV negative, even though they have not taken a test. Two common situations in which HIV testing is compulsory are pre-employment testing {testing job applicants} and pre-marital testing {testing couples before they get married}.

Pre-employment testing is an abuse of human rights. However, some employers continue to test job applicants, often without their knowledge or consent. Pre-employment testing for HIV is: 
 

bullet

discriminatory, because it stigmatises prospective employees and excludes them from employment 

bullet

ineffective, because it does not provide accurate information about people's HIV status - the test result may be negative because of the window period, and the person being tested may become infected later 

bullet

expensive and wasteful, because it diverts resources that could be spent on prevention, education and care.

 
 

Pre-employment testing 

The Zimbabwe National Code of Practice on HIV/AIDS and Employment states that: 
 

bullet

there shall be no pre-employment testing of HIV. Employees shall be given the normal medical tests of current fitness for work and these shall not include HIV testing.

bullet

there shall be no indirect screening, such as through questions in written or verbal form or enquiries about previous tests.

bullet

there shall be no compulsory workplace testing for HIV

bullet

people with HIV have the right to confidentiality about their HIV status in any aspect of their employment

bullet

information regarding HIV status shall not be disclosed without an employee's written consent.

bullet

there shall be no compulsory HIV testing for training. HIV status shall not be a criteria for refusing to train and develop an employee.


Similarly, in South Africa, the new Employment Equity Bill bans pre-employment testing for HIV. However, pre-employment testing is still carried out and people who are found to have HIV are often denied employment or offered sub-standard conditions. Pre-benefit screening for HIV - for example, for obtaining medical insurance - is not banned. One problem is that workers are often unaware of the law and their rights, or have no access to legal help or the chance to enforce existing laws.

Eskom, a large public enterprise in South Africa with a workforce of about 40,000, stopped mandatory pre-employment HIV testing in 1993, because they found that it had no benefits and was not cost-effective. The company had spent Rand 200,000 (about US$33,000) in three years conducting 10,000 tests to detect 14 cases of HIV. 

The company decided instead to focus its resources on planning for human resource management, counselling, condom provision, peer education and improving treatment for sexually transmitted infections and community outreach. In addition to monitoring prevalence in the workforce through voluntary, confidential, anonymous testing.


Pre-marital testing may help couples who are planning to get married, if both partners are prepared for the test and counselled. However, if one partner. tests positive, they may be prevented or prohibited by law from marrying, even when their partner wants to marry them. It is essential that pre-marital testing is voluntary and confidential.

 

    



 

 
top of page

• Home • Site Map • About Us • AIDS action • Caring with confidence • HIV and safe motherhood • HIV testing • Making Sex Work Safe • Men's sexual health matters • Steps to making sex safer • HIV/AIDS Resource Pack
 

The Mother and Child Health and Education Trust
a U.S. 501(c)(3) non profit organization
our portals and sites