The test of any man lies in action

I've written before - and I'm sure I'll write again - about the figures, So often we read the reports, we see that figures, but we don't think much about what the figures mean. We all know that 'mortality' means real people dying, but in reports it can become just another statistic.

I've just been working on the final draft of our annual report. Among others, we generally comment on the fact that only a small proportion of people with HIV infection in Indonesia are aware of it. There seems to be agreement that the total number of people living with HIV in Indonesia is around 270,000 - I think that's a low estimate, but let's accept it for the moment. The last annual statistics from the Ministry of Health note that less than 5,500 new cases of HIV infection were reported last year. So I did a little calculation: at that rate, it'll take us 50 years to identify all the current cases. Of course, most of them will have died by then, but...

OK, the reported case numbers are notoriously low. Figures from the provinces are usually at least twice those reported nationally (ask why?). But even if we assume we're finding 10,000 cases a year, it'll still take us more than 25 years to find them all.

There's been priority given to scaling up voluntary counselling and testing (VCT) over the last couple of years, with massive injection of Global Fund money. So what have we achieved? A 30% increased in case detection over the last two years! Gee!

'We' regularly discuss (or argue about) introducing provider initiated counselling and testing (PICT), with opt-out. 'We' are not sure what that means, but are scared that it will violate human rights. Fact is that probably a majority of the 5,500 cases reported last year were identified among in-patients in hospitals; the symptoms suggested AIDS-related infection, the history suggested possible risk, the doctor (finally) connected the dots, and the patient was referred to the VCT clinic. That sounds to me like provider initiated testing, no? So what's the problem?

Well, the problem is that the doctor in his office does not connect the dots - how can he (or she) in five minutes consultation? Thus the whole argument seems moot to me: PICT is already happening in hospitals and is not feasible in out-patient practice.

So do we just wait 25 years? With people are getting infected MUCH faster than we're identifying them...

Babé