The debates around HIV testing often focus on the false dichotomy between Voluntary Counseling and Testing (dismissed as the old “failed” approach, despite never having been adequately funded, and working remarkably well in many places with lots of interest but still small overall percentages of populations being tested) and Routine Provider Initiated Counseling and Testing (where patients can, supposedly, opt-out). Routine testing has been promoted even where there are no links to care and support services or to medical treatment.
A recent project in Uganda shows an alternative, more comprehensive, approach. A pilot project conducted by Home-Based AIDS Care combines testing and counseling and, perhaps most notably, takes place in homes. People involved with the Home-Based AIDS Care project overwhelmingly opted to get tested, received counseling whether HIV positive or not, and experienced less stigma from their community. They also were guaranteed access to clinical care and antiretroviral therapy if needed.
The study found that, three months after the diagnosis, there was “substantial increase among positive social events, such as strengthened relationships and community support, and no increase in negative events”. This is likely due to the attention and affirmation that both HIV-positive and -negative individuals in the community received.
Importantly, this technique is considered “operationally feasible” from a financial perspective. This stems in part from targeting entire households which often house several individuals with HIV. Additionally, it promises to be sustainable: as stigma within the community lessens as a result of the counseling, there could be a move towards heightened comfort with methods of protection and earlier testing and treatment.
Uganda is perhaps more able to succeed in these types of programs because they have a long history directly addressing stigma and supporting grassroots initiatives. Other countries in sub-Saharan Africa may have less success, but it is good to see a model of what might be possible.