Editorial Comment: Counselling and HIV self-test kits need linking

As Zimbabwe continues to battle the ravages of HIV, any development that takes us closer to zero percent new infections and zero deaths is great.

The introduction of self-testing kits which will help increase the number of people who know their HIV status are welcome. In a country of 14 million people it is disheartening to know that slightly over two million people know their HIV status.

The law criminalises wilful transmission of HIV which means that those who know their status and do not take steps to protect those they come into contact with are liable for prosecution. But on the other hand chances are high that those who have not been tested are also spreading the virus. Thus everyone should know their HIV status.

Unfortunately stigma remains a strong social ill barring people from getting tested and accessing life saving treatment. Too many people only get tested when they are in obvious ill health. Then treatment is costly and their bodies are ravaged.

Current World Health Organisation guidelines advise that those infected with HIV be initiated on anti-retroviral drugs while their immune systems are still good. The only way that can happen is if one knows their status early enough and hopefully the self-test kits would encourage more people to seek to know their status.

That said we have reservations about the self-testing kits. There are a few points which we hope have been considered before the roll out commences. The Ministry of Health and Child Care says that they will only give the kits to people aged 16 and above. This effectively means that children below that age remain locked out of access to HIV testing.

We hope that the policymakers are crafting programmes to increase the number of children getting tested. With children becoming sexually active at increasingly young ages, no HIV programming will be effective without robust in-built “catch them young” mechanisms.

There is also danger that adults with access to the test may administer them on children who will then learn of their status in a manner that may be highly distressing.

There are also other segments of the population that continue to be left out of the equation. It appears that while the communication team for the self-test have worked hard to ensure that instructions are more accessible to Shona speakers of little literacy, little has been done to also bring on board the visually and aurally handicapped.

These groups have been left in most awareness and information communications and seem to be fated to remain on the sidelines. But they too need to be part of the fight against HIV as they are infected and affected just like everyone else.

Another cloudy issue is that of counselling. Voluntary counselling centres manned by trained counsellors help many people accept their HIV status, positive or negative. The counsellors are also on hand to give immediate support, information and direction to those who would have tested positive.

That initial period after receiving results is fraught with shock, anger and other complex emotions. So even with professional support, some people go into denial or fail to cope leading to suicide and murder. What will the picture be like for those who have to deal with the results alone?

We also wonder how the programmers will convince people who would have tested HIV positive to go to a health centre for treatment. If a person fears stigma to the extent of failing to go to a health facility to get tested, how likely are they to seek treatment after self administered diagnosis?

Another point to ponder is on the link between HIV and gender-based violence. Many women have suffered violence when they tell their partners that they have tested positive for HIV. We hope the self-test kits will not increase incidences of intimate partner violence especially in serodiscordant couples.

But as we stated earlier in spite of our reservations, we are all for the idea of empowering as many people as possible to know their HIV status.

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