HIV testing at home is a milestone

The idea of home-based self-testing for HIV has existed since the mid-1990s in many parts of the world, but implementation has not been without debate and controversy.But with over 52 local pilot studies showing Kenyans are receptive to self-testing, and with local experts extolling the initiative as a good way of boosting the uptake of HIV testing, providing individuals with self-testing kits deserves due consideration.According to the National Aids and STI Control Programme (Nascop), legalising home-based tests could increase HIV tests to five million from the current 2.5 million, achieved through antenatal clinics and in voluntary counselling and testing centres (VCTs).One thing that is not in doubt is that numerous HIV infections happen among people who do not know their status. It is estimated 200 new infections happen in Kenya every day.Additionally, evidence supports the notion that early detection and diagnosis expedites early treatment and linkage to care while facilitating the modification of risky behaviour and promoting HIV prevention.Self-testing provides the best chance of destigmatising HIV testing. Indeed, surveys have shown that in populations where a majority of people know their status, stigma is reduced.For instance, in the North-Eastern Province, where only about 10 per cent of adults have taken an HIV test at least once, stigma is highest. According to Nascop, about 60 per cent of men and women in Kenya have taken an HIV test at least once.In the face of such overwhelming positive evidence and with effective HIV treatment now available, many of the arguments against self-testing are out of date.Such arguments, which have included claims that people will not cope with the results and can commit suicides, should not deter the country from pressing forward with the implementation of the self-testing kit.With one of the HIV self-test pilot studies at Kenyatta National Hospital revealing that 97 per cent of people who participated took the kit home and even tested with their spouses, it is evident that HIV self-testing is a good idea that presents tremendous opportunity. It is time to empower people with this unique testing procedure.Whenever the issue of offering self-testing to the public is discussed, the matter of accuracy always emerges. But HIV experts say the accuracy of new self-test kits match other types of HIV tests.Also, critics of the approach say that since test results are considered ‘preliminary positive’ undertaking confirmatory testing would be ignored. But this already happens in clinics, where many people who get a positive same-day-test result do not return for a confirmatory test.Another objection to self-testing being freely accessible is the claim that it presents the possibility that some people may be tested without their consent. However, this should not be used to bar Kenyans from benefiting from this initiative. Such fears can be allayed through a law that makes non-consensual testing illegal.Finally, the other protestation of self-testing method has been that lack of counselling services before and after the test may result in domestic violence in case test results are positive.But even with the current testing technologies today, HIV testing still remains an individual choice among couples. The proposals to provide pre-testing instructions and a help hotline for users to call before or after the test will make first step towards finding a solution.The Kenya Demographic Health Survey 2008/2009 indicates only 56.5 per cent of females have ever had a HIV test against some 40.4 males, on an age range of between 15 to 49 years.However, with HIV testing technology developing more effective and faster options – urine, blood and mucosal fluid – the restriction of HIV testing to clinical settings may be unwarranted as it prevents individuals from exercising their autonomy.

HIV testing at home is a milestone

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