Zimbabwe's ambitious plan to offer an HIV test to every household in the country is not yet under way but is already being met with scepticism by activists who feel this is not a priority for the country, especially with global HIV/AIDS funding on the decline.
Owen Mugurungi, national coordinator of the HIV/AIDS and Tuberculosis Unit, told IRIN/PlusNews the government wanted every sexually active Zimbabwean to know their status by 2015 by bringing HIV testing closer to the people. “We have not secured additional funds for this initiative but I think that with the little available resources from the AIDS Levy we can start with a pilot in a few districts. Lessons learnt from the pilot programme will be used in the phased rollout of the programme," he said.
The AIDS levy - a 3 percent tax on income - has become a promising source of funding for the country in recent years - an estimated US$20.5 million was collected in 2010; with most of the money being used to purchase antiretroviral (ARV) medication.
“Prevention, prevention and prevention is the only way we can control the epidemic; that is why HIV testing and counselling are critical,” he added.
HIV prevalence in Zimbabwe has declined remarkably in recent years, dropping from 26 percent to 14 percent between 1997 and 2009; however, at 13 percent now, it remains one of the highest in the world.
Tinashe Mundawarara, programme manager for the HIV/AIDS, Human Rights and Law Project at the Zimbabwe Lawyers for Human Rights, warns of the possibility of compromising on informed consent and confidentiality when testing is done on a large scale.
“When properly done, door-to-door testing has its advantages, for example, reaching out to people who ordinarily face challenges in accessing Voluntary Counselling and Testing,” said Mundawarara. "When this is not properly done, there are high chances of ostracism, violence, stigma and abuse in the home because disclosure will take new dimensions that are not anticipated given the complex scenario of the home environment.”
Door-to-door testing was successfully piloted in Bushenyi District, in western Uganda, between January 2005 and February 2007, reaching 63 percent of all households. A study of the impact of the programme found that the benefits of home counselling and testing were far-reaching.
But in 2008 Human Rights Watch and the AIDS and Rights Alliance for Southern Africa (ARASA) jointly conducted research on Lesotho's “Know Your Status” door-to-door testing campaign, which planned to offer 1.3 million people an HIV test within two years. The report found that many counsellors were ill-equipped to conduct HIV counselling and testing, and the counselling they provided was often substandard, raising concern about whether people’s consent to test — or their decision not to test — was actually informed.
In addition, the household testing campaign would require a lot of funding. “The challenge here is whether to use resources for identifying new HIV-positive clients for information or statistical purposes or to use the same resources to provide treatment for those already identified who need treatment now,” Mundawarara said.
Activists have also raised concerns about whether the testing campaign will go beyond merely testing people, and whether it will motivate them to change their sexual behaviours and also refer those testing positive to treatment facilities.
At least 1.2 million people are estimated to be living with HIV in Zimbabwe. Of these 347,000 are accessing treatment through the state-run programme, while another 600,000 urgently need ARVs. With limited money to scale up the provision of ARVs, the healthcare system would not have the capacity to treat those testing positive during the campaign, activists have cautioned.
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According to AIDS activist Tendayi Westerhof, the time for such campaigns has long passed, and the government should be focusing on using the little resources available to strengthen its treatment programme and consolidate prevention strategies such as male circumcision and condom distribution.
“It makes economic sense that the little resources available must be focused on the Prevention of Mother to Child Transmission and ARVs for people living with HIV who are in urgent need of treatment. Zimbabwe is among the 23 countries that are implementing the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.”
But Mugurungi insists government is focused on universal access to HIV prevention and treatment in line with the Millennium Development Goals and commitments of the UN High-Level Meeting on AIDS of June 2011.
“It would be narrow-minded to focus on treatment while leaving out prevention. After all, HIV testing and counselling is an entry point to HIV care and treatment, support and mitigation, so those who are advocating for more funds for treatment should be reminded that if people don't know their status they will not access treatment and people will continue to present late for treatment and might die, yet drugs are available and stockpiled,” said Mugurungi.