Promoting ‘opt-out’ testing in

Promoting ‘opt-out’ testing in an environment of stigma and discrimination

The report notes that one of the major hurdles in access to treatment and other services for AIDS is stigma and discrimination associated with HIV: social stigma that can result in positive women suffering domestic violence; institutional discrimination that can deny health care, education and other social services to people who test positive and their children. Stigma preventing women from coming forward for testing is a significant barrier to wider coverage. Research in India, Pakistan, Nepal and Bangladesh has shown that stigma and discrimination against children affected by AIDS prevent children from using basic social services

So it is puzzling that the report views routine ‘opt out testing’ – in which all women are tested unless they state that they do not want to participate -- as a key element of identifying and reaching children in need of treatment. It only suggests that an expansion in testing services should be accompanied by “referral to legal services or village authorities who can deal with such cases” – a practice that could be useless and even worsen the situation for women.

In India, 2006

• There were an estimated 70,489 pregnant, HIV-positive women in India.
• 7,007 HIV-positive pregnant women got ART through the PMTCT programme (in India renamed the Prevention of Parent To Child Transmission programme or PPTCT programme) – or 10% of those who needed it.
• As of end-2006, 2,959 children (between the ages of 0 and 14 years) were on antiretrovirals).
• 17% of men aged 15-24 had “comprehensive knowledge of HIV in 2000-2002 (correctly identify the two major means of preventing HIV transmission, reject common misconceptions and know that healthy-looking people can transmit HIV), going up to 36% in 2003-2006.