Attitudes to HIV testing formed during the early 1980s are inappropriate for combating the world’s greatest public health challenge, and the human rights platform on which global HIV prevention is based needs to be re-considered, according to Dr Kevin de Cock of the US Centers for Disease Control. Dr de Cock was speaking in the opening session of the Eighth Annual Retroviruses Conference in Chicago.
He asked whether the United States would stand by and permit a lack of efforts to identify infected individuals if it faced 25% HIV prevalence rates, and whether it was appropriate to maintain such an approach in Africa.
“The human rights/AIDS exceptionalism approach is promoting an African holocaust. We will ultimately have to account for our passivity in the face of the continent’s biggest catastrophe since slavery”, he told the conference, challenging the consensus in favour of voluntary confidential testing which has dominated global prevention efforts for the past fifteen years.
“Routine universal confidential testing in all health care settings is the most rational approach, even in the absence of treatment.”
Routine universal testing of pregnant women during delivery with provision of nevirapine is one example of the approach that should be adopted, he said, citing the example of Botswana, where only 221 HIV-positive mothers out of a potential 2,800 had been identified by voluntary testing and offered AZT prophylaxis in 2000 under the country’s perinatal transmission prevention programme.
“Societies determine their own death rate [in the public health policies they choose]”, he said.
Pointing out that the number of African children orphaned by AIDS now outsrips the total number of refugees and misplaced persons on the continent, with serious implications for future stability, he argued that the prevention of orphanhood requires the identification of serodiscordant couples so that prevention efforts can be more tightly focussed to prevent the infection and death of both parents.
He also argued that such policies need to be extended to the United States in order to address the stabilisation of new AIDS diagnosis over the past two years despite the availability of HAART. After a sharp decline after 1994, new AIDS diagnoses have plateaued and are increasingly concentrated in the most economically marginalized sections of the community.
“Forty per cent of those diagnosed with [an AIDS defining illness] in the United States did not know their HIV status. Those who go uncounted count for nothing when funding is handed out”.