God screens us evermore

There's been much uninformed discussion regarding Provider-Initiated Testing and Counselling (PITC - or is it PICT?) here. Nobody seems willing to come up with a clear definition of what we mean by this, let alone achieving a consensus on how it might be implemented. But it is abundantly clear (as I have written before) that the current practice of VCT will take more than 25 years to identify those who are infected today.

It's clear as well that most of the HIV testing taking place in hospitals in effectively provider-initiated. A sick patient is admitted; the doctor (finally) suspects an opportunistic infection, the patient admits previous risk behaviour, so the patient gets referred for VCT, perhaps getting counselling, perhaps just having blood taken in the same way as for other tests. So effectively we wait until the person falls sick, often with a badly damaged immune system, before we diagnose the underlying condition.

Several WHO experts have proposed annual universal testing of all people over the age of 15 years for HIV. This is clearly not yet feasible, and thus has often been rejected. But the fact is that we must find a better way to identify the 95% of people infected with HIV here before they fall sick with very nasty conditions.

The military have it easier, A report on the Indonesian armed forces web site recently described mass testing of a Marine unit. Unfortunately the article is peppered with so many military acronyms, it's a little difficult to understand, but this photo helps. The article refers to 'early detection through Blood Screening Tests', but it does appear that it is not 'unlinked-anonymous' - as if that would be possible in the military! It also reports that the 'marines welcomed the blood-letting enthusiastically, proved by the attendance of all ranks of the unit.' Does that mean it was not in fact compulsory? Only obligatory, perhaps.

Let's hope that those diagnosed with HIV remain enthusiastic. The military is now trying to come to grips with HIV, and total isolation inflicted on 16 members of the peacekeeping force returning Cambodia with HIV in the 90's is hopefully a thing of the past. But HIV-positive soldiers are still often removed from active service, generally posted to the medical corps, where they while away their days. But at least they now get treatment.

The Marines say their top brass now give great attention to HIV, including with 'Peer Leader HIV Training'. So far no reports of formation of peer support groups for marines known to be HIV-positive. Maybe we need to take more initiative...

Babé