Commentary & Opinion
Letters to Editor Respond to Holbrooke, Furman Opinion Piece on HIV Testing in Africa
February 17, 2004
Richard Holbrooke, former U.N. ambassador and president of the Global Business Coalition on HIV/AIDS, and Richard Furman, founder of World Medical Mission last week in a New York Times opinion piece wrote that routine HIV testing is "virtually absent" in most countries, and the lack of testing "undermine[s] overall progress" in the fight against AIDS. They said that international policy on testing "must be changed" from the current "Voluntary Counseling and Testing" model to "Confidential and Recommended (or Routine) Counseling and Testing," adding that HIV testing should be required at marriage, before childbirth and during any hospital visit (Kaiser Daily HIV/AIDS Report, 2/10). Several letters to the editor responded to the opinion piece. Summaries follow:
- Patrick Friel, World Health Organization's Global Program on AIDS: Holbrooke and Furman "have a powerful idea, one that has been neglected for a long time," Friel, who worked with WHO's Global Program on AIDS from 1988 to 1995, writes in a Times letter to the editor. Although "testing will never catch on until there is complete assurance that people who test positive can obtain treatment ... widespread testing is a great opportunity to actively integrate 'prevention' with 'treatment and care' because counseling and testing are essential to the working of both," Friel says, adding, "I say, let's go for it!" (Friel, New York Times, 2/15).
- Kim Nichols, African Services Committee: Holbrooke and Furman are "correct" that testing is the "missing intervention in breaking the chain of HIV transmission globally," Nichols, co-executive director of the African Services Committee, writes in a Times letter to the editor. However, "testing need not be mandatory to be widely used," Nichols says. Many people at high risk of getting HIV "[w]hen given the choice ... choose to learn their status," Pollack says, concluding, "Mandatory testing at specified life stages is more likely to discourage people who need it most from seeking routine health care" (Nichols, New York Times, 2/15).
- Amy Pollack, EngenderHealth: VCT centers in Africa do offer rapid HIV testing, Pollack, president of EngenderHealth, writes in a Times letter to the editor, adding, "What they don't offer is real counseling or treatment." Because these centers are unable to "ensure these two essential services, recommended, routine or required testing would miserably fail to offer people anything in return," Pollack says, concluding, "Surely, in such a setting, the V for voluntary is imperative" (Pollack, New York Times, 2/16).
- Leonard Rubenstein, Physicians for Human Rights: Although Holbrooke and Furman are correct that testing is a "crucial element of a comprehensive AIDS strategy, ... their diagnosis of the problem in Uganda is incomplete," Rubenstein, executive director of Physicians for Human Rights, writes in a Times letter to the editor. Testing is often unavailable and when it is, "people tested gain little in return except discrimination, much of it virulent," Rubenstein says, concluding, "Until the health system is strengthened, the promise of counseling and treatment becomes real and the government does more to end discrimination against people who are HIV-positive, testing will not succeed" (Rubenstein, New York Times, 2/15).
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Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2004 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.