7 February 2013

Uganda: Compulsory HIV Testing Starts

All people who seek treatment in public health centres across the country will undergo mandatory HIV testing under a plan to increase access to HIV prevention and treatment, the health ministry has said.

Under the multi-million dollar programme code-named 'provider-initiated testing', HIV counselling and testing will be incorporated in the routine medical care, according to Dr. Alex Ario, the acting manager of the AIDS Control Programme.

The UN World Health Organisation issued guidelines for healthcare provider-initiated counselling and testing in 2007.

In Uganda, mandatory testing was first piloted on expectant mothers attending antenatal care and general patients at regional referral hospitals in 2009. However, Ario said the system would be rolled out to cover health centre IIIs and IVs across the country this year. Some private health facilities that receive supplies from the Government will also implement the programme at no cost to patients.

"Mandatory HIV testing will now be part of the many tests conducted whenever a patient is admitted. It will be part and parcel of our routine medical care practice to let more people know their status to augment HIV prevention and treatment campaigns," said Ario. He, however, explained that even when the tests are done, patients will not be compelled to know their results.

"Mandatory testing is advantageous to us health workers as well as the patients. It will promote better management of ailments. But this does not mean that patients will not be counselled," Ario said. "If a patient is unwilling to know his HIV status on the first visit to the health centre, we shall wait until he returns and is ready to receive the results," he added.

Uganda employs a number of testing strategies, including routine HIV testing for pregnant women, client-initiated counselling and testing, home-based HIV testing, couples HIV testing, mobile HIV testing and moonlight (night-time) testing for high-risk groups such as sex workers.

According to government statistics, HIV testing is available at 80% of county-level health centres, but only 22% of sub-county-level health centres. The number of people tested for HIV annually has gone up from 1.1 million in 2008 to 5.5 million in 2011. The new strategy is part of efforts to lower Uganda's HIV prevalence, which climbed from 6.4% to 7.3% between 2006 and 2011.

Studies have shown that beyond the benefits of having HIV-positive people identified and referred for treatment, provider-initiated counselling and testing may also result in less risky sexual behaviour, thus reducing levels of HIV transmission.

"There are so many benefits of knowing one's HIV status. Those who are HIV-negative will be careful and avoid engaging in risky behaviour. They will carry out preventive options such as partner notification, abstinence and safer sex," Ario told IRIN/PlusNews. "Those who are HIV-positive will be enrolled in antiretroviral treatment and have increased opportunities for social support to live normally."

Anti-HIV activists welcomed the start of the new programme, but warned that the Government must improve the health system in order to cope with the likely increase in the numbers of those in need of treatment.

"It's a good initiative. It will enable people to guard and take care of themselves. But our health system is struggling. It has not measured up. We have shortages of health workers in the health facilities," Florence Buluba, the executive director of the National Community of Women Living with AIDS, told IRIN. "The Government first needs to address the challenges the health sector is facing before rolling out the programme."

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