With many people frightened to go to public hospitals to be tested for HIV, in case someone sees them, home-testing kits could be the ideal solution - if only they were legal.
Kenya did it. So too did the US, the UK and recently Australia. They have all legalised the sale of HIV self-testing kits in a move to make testing and treatment for HIV easier and more accessible. But in Malawi we are still waiting.
In a recently published report by UNAIDS, 19 million of the 35 million people living with HIV today do not know that they have the virus.
The report further shows that people will seek life-saving treatment the moment they find out they are living with HIV as demonstrated in sub-Saharan Africa where 86 per cent of people who tested positive for HIV went on to access antiretroviral therapy (ART) and nearly 76 per cent of them have achieved viral suppression (page 9 of UNAIDS’ The Gap Report).
Fear of exposure at public hospitals
Stephen (not his real name), a 22-year-old college student living in Blantyre, Malawi, prefers to use a private clinic whenever he wants to undergo HIV testing.
“I usually go for Banja La Mtsogolo for testing,” he said. “I am afraid to go to the public hospital because of the queues. When people see me there won’t they think I am already living with the virus?”
He added that while interaction with staff at the private clinics is on a one-to-one basis, there are a lot of workers in public hospitals and he is unsure how many people would have access to his results.
Self-testing allows privacy
These fears were also highlighted in a joint study by Malawi Liverpool Wellcome Trust and Malawi College of Medicine on the uptake and accuracy of oral kits for HIV self-testing across some townships in Blantyre, which was carried out in 2011.
According to the study co-ordinator, Augustine Choko, the results indicated that more people were willing to self-test for HIV within the confines of their homes due to the fact that it offered them ‘privacy and convenience’.
“So far 12,970 people recorded in the study are reported to have done self-testing within the townships of Ndirande, Likhubula and Chilomoni in Blantyre, representing a 78 percent uptake of self-testing,” said Choko.
Malawi yet to approve self-testing
Malawi is one of many countries that has not yet approved over the counter sale of HIV self-testing kits. When asked to comment on how soon the service will be approved, Henry Chimbali – spokesperson for Malawi’s Minister of Health –stated that there is no self-testing in the national HIV/AIDS policy and guidelines and therefore could not provide any further information.
UNAIDS states more documentation is needed to inform the development of the World Health Organisation’s guidance on self-testing despite promising results in both generalized and concentrated epidemic settings.
Population Service International (PSI) Malawi is one of the organisations which have sexual and reproductive health programs targeting young people.
Some of its services include a radio program delivering sexual reproductive services for young people between the ages of 10-24.
Reproductive health program manager at PSI Malawi Sungani Ndovi, observed that in their line of work, there are many factors limiting young people from accessing services including challenges with commodity supply to health facilities, limited availability of human resources for health and trained service providers.
Youth and access to HIV testing
While confirming that some young people do not like accessing reproductive health services including HIV testing in public hospitals for fear of their privacy and confidentiality, Ndovi observed that the problem lies with the perception in the youth.
“We have also observed that young people have a perception about negative provider attitudes which influences their interest to seek youth-friendly health services,” said Ndovi. “These [fear of privacy and confidentiality] are just some of the assumptions and fears that young people have. These providers have been trained, are qualified and well-equipped to provide services to young people. They also respect and uphold basic health rights such as this.”
With this perception – justified or not – among young people, not imparting youth-friendly information about sexual and reproductive services, including voluntary counselling and testing, discourages young people from accessing them and is tantamount to unavailability of the same.
Like Elizabeth Taylor said, it is bad enough that people are dying of Aids, but no one should die of ignorance.
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