Business Day (Johannesburg)

South Africa: Push for Routine Offers of HIV Tests

Tamar Kahn

11 November 2009


Cape Town — Health Minister Aaron Motsoaledi is pushing for a radical change in SA's approach to HIV testing, proposing that doctors and nurses routinely offer screening to all their patients instead of waiting for them to volunteer or get AIDS- related illnesses.

People would still be able to decline the offer of an HIV test.

At the same time, Motsoaledi is leading a government charge to get more people to take voluntary tests. Both measures are meant to increase acceptance of testing and raise the proportion of HIV-positive people who know their status, in the hope that they will take precautions to protect others from infection and seek help if they fall ill.

SA has an estimated 5,3-million people infected with HIV, according to the Department of Health. Yet few of them know their status; last year only a quarter of South Africans had taken a test in the previous 12 months, according to the Human Sciences Research Council.

Motsoaledi said he expected the Cabinet and other leaders to be at the forefront of a huge public HIV testing campaign, possibly on World AIDS Day on December 1 -- yet another mark of the current administration's clear break with the Mbeki era's lacklustre efforts .

"I will ask him (Zuma) to be in front of the queue, and indications are that he will agree," Motsoaledi told reporters yesterday. "And I told the bishops to lead their flocks," he said, referring to a recent meeting with religious leaders.

While prominent South Africans have on occasion taken public HIV tests there has not yet been a co- ordinated campaign involving high- profile figures. Public HIV tests for senior politicians became a contentious issue under the previous administration as neither former president Thabo Mbeki nor his health minister Manto Tshabalala- Msimang would take a such a step, defending their position as a personal matter. Tshabalala-Msimang was so irritated by Business Day's questions at a press conference two years ago that she broke into Russian, which she had learnt during her time in exile. Tshabalala-Msimang did take a blood pressure test at a public event in a Cape Town township several years ago, in order to encourage people to follow suit.

By contrast, Zuma took a public HIV test in rural KwaZulu-Natal in March 2007, and the then deputy health minister Nozizwe Madlala- Routledge, in no less deliberate fashion, did so too.

The progression of the pan demic could be reversed with appropriate leadership, Motsoaledi said, citing the example of the Western Cape which broke ranks with national government. The province provided HIV-positive mothers with two drugs instead of one to reduce the risk of mother-to-child transmission of HIV. Dual therapy enabled the Western Cape to significantly cut its AIDS- related infant mortality rate.

Motsoaledi said he had asked the South African National AIDS Council to review SA's capacity to conduct a huge voluntary HIV testing campaign and to determine whether the facilities existed to provide care to the people identified as infected.

Francois Venter, President of the Southern African HIV Clinicians Society, welcomed Motsoaledi's suggestion of introducing provider- initiated HIV testing, saying such tests should be routinely offered.

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