WHO's Idea for Universal HIV Testing Raises Hopes, Fears

AIDS experts and public health advocates are weighing in on a recent study that suggested the AIDS epidemic could be reversed by an aggressive test-and-treat strategy.

"Universal and annual voluntary testing followed by immediate antiretroviral therapy treatment can reduce new HIV cases by 95 percent within 10 years," according to the mathematical modeling study by World Health Organization researchers, who used data from South Africa and Malawi. [The study was published in The Lancet; a summary appeared in Thursday's PNU.]

Experts greeted the findings with hope but raised several cautionary issues.

"We have to look carefully at how people are being tested, by whom, if they are being properly counseled, if it is truly voluntary," said Patricia Daoust, director of the Physicians for Human Rights' Health Action AIDS Campaign.

"Concerning annual voluntary testing, it's difficult to imagine you get 100 percent testing [while] making sure it is confidential and voluntary," said Kevin Moody of the Global Network of People Living with HIV/AIDS. "There is still a lot of stigma and discrimination against [HIV-positive] people, so it is important to work with countries to make a safe environment for people to get tested."

"Currently, the upscale of prevention and treatment programs is undermined by gender inequality, violence against women, against sexual minorities, mandatory testing, lack of confidentiality, stigma and discrimination, and criminalization of sex workers and drug users," said Mandeep Dhaliwal of the UN Development Program's HIV/AIDS division.

Seth Berkley, president of the International AIDS Vaccine Initiative, voiced concern about the effects of drug resistance on such a program. "First-line antiretrovirals have become less toxic, but second- and third-line treatments, which would be required when drug resistance occurs, are much more toxic and much more expensive." Berkley acknowledged that "in theory, this new model would work," but he added, "given the impracticality of this intervention, it is unlikely to work in a real life situation."

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