UNAIDS will introduce new HIV testing guidelines in India in March that recommend health provider-initiated testing and counselling (PITC). But the decision to go for it will lie with the people. Currently, people are tested only if they ask for a screening. Since very few ask for a test, only one in 10 people with HIV know their positive status.
“PITC would increase the number of people getting tested phenomenally, as it has happened in several east African countries like Botswana, Malawi and Uganda,” says Denis Broun, UNAIDS India coordinator, speaking to the HT from Thailand. “The new guidelines aim to reach the nine in 10 undiagnosed people who miss out on treatment.”
But human rights advocates fear India does not have the health infrastructure to treat and care for the thousands who will test positive. “The government cannot test people and send them away. India first needs to ensure proper counselling, upgrade voluntary testing and counselling centres, and set up the required facilities in states that have no health infrastructure or social security for people to fall back on,” says Anjali Gopalan, executive director of the Naz Foundation, which runs a hospice for positive people and a home for AIDS orphans in Delhi.
If provider-initiated testing is taken up, the government also needs to ensure that testing does not become an imposition. According to the International Labour Organisation, fear of losing employment often discourages individuals from getting tested. “Before scaling up HIV testing, the government must ensure there is no stigma and discrimination. They must also provide assured access to treatment and care services,” says Loon Gangte, president, Delhi Network of Positive People.
In the new UNAIDS guidelines, the emphasis is on informed consent and counselling before testing. “UNAIDS does not support mandatory testing. Testing must be confidential, include counselling and occur only with informed consent. No one will be forced into testing as the rules of opting out are very clear,” says Broun.
The guidelines have been formed on the premise that people who do not know their status cannot obtain the appropriate health care, including antiretroviral therapy, and pregnant women cannot take advantage of measures to stop the transmission of the virus to their unborn children.
Several countries are choosing routine testing to ensure more people get tested and get treated. In September, the US Centers for Disease Control recommended routine but voluntary HIV screening for people between 13 and 64 years in health settings.