HIV testing without treatment? (7)
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As a research fellow at the National School of Public Health at
MEDUNSA (Medical University of Southern Africa), I have developed the
first draft of the screening and surveillance section of an AIDS Re-
search Consortium Proposal. Currently, I am planning to pilot some
aspects of that proposal in a rural community, including confidential
antenatal HIV testing presented as a routine procedure. Response to
this idea has been varied, from one university researcher who felt
that the women will have more to lose than gain from testing (e.g.,
their relationships may be in jeopardy if they test positive) to the
nurses in the rural clinic, who feel that this is a very worthwhile
effort. A small, impromptu focus group of new antenatal patients this
morning suggested that these women trust the clinic to maintain con-
fidentiality and feel that it is of benefit to know one's status, as
long as it is voluntary. One of the focus group members had in fact
just been voluntarily tested.
It is my feeling that we must carefully balance the risk versus bene-
fit in each situation. I chose a small pilot study of new antenatal
patients knowing that drugs to prevent vertical transmission are
"just around the corner," and we will need to have procedures in
place for HIV testing. I can justify this study by insuring that all
clinic staff are thoroughly trained in pre and post test counselling
and that they will offer nutritional counselling, information about
possible opportunistic infections in the women and/or their babies,
information about the risks versus benefits of breast feeding as well
as psychological support to those who test positive. Regarding the
query, "Should we consider reallocating some of the resources spent
on HIV testing to the provision of care services?" I would have to
say yes, if we cannot provide enough benefit from testing to outweigh
the risks to the individuals involved.
Pamela Rachel Gross, MD, MPH
Postdoctoral Fellow
National School of Public Health
MEDUNSA
South Africa
mailto:pamgross@mweb.co.za
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