Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
The San Francisco Chronicle - Monday, July 10, 2000
Sabin Russell, Chronicle Staff Writer
Voluntary testing and counseling are central to AIDS prevention efforts in the West, but are a luxury in Africa. Of the 24.5 million people in sub-Saharan Africa infected with the AIDS virus, only 10 percent know they are infected. Now researchers say they have the data to show that improving that percentage could curb the growth of the epidemic. "When people find out they have HIV, they change their behavior," said Tom Coates, director of the University of California at San Francisco's AIDS Research Institute.
Coates is lead author of a paper released yesterday in the British journal The Lancet, one of three articles examining the role of testing in AIDS prevention. The research was commissioned by the United Nations and the U.S. government.
Coates said in an interview here that an experimental program of testing and counseling, which cost about $27 per person to run, produced a "profound behavior change" among participants, particularly those who were found to be HIV-positive.
Although testing positive means it is too late to prevent an infection, a change in behavior can reduce the chances that the person will infect another sexual partner. The study was conducted in Kenya, Tanzania and Trinidad during a three-year period ended in 1997.
As summarized by Coates, the program of testing and counseling reduced unsafe sexual behavior by 38 percent among men and women who were found to be HIV- negative, and 60 to 70 percent among those found to be HIV- positive.
That translates into a 20 percent reduction in new infections among the lower risk population of HIV-negatives, and a 30 percent to 35 percent reduction in new infections among partners of HIV positives.
A companion study led by Michael Sweat of Johns Hopkins University used Coates' data and computed the cost and benefits of such a program in Tanzania and Kenya. He found that if 10,000 clients received counseling and testing each year, it would cost $249 for each HIV infection averted in Kenya, and $346 for each averted in Tanzania.
In terms of cost effectiveness, the program compared favorably with other commonly practiced public health measures, such as measles vaccinations and immunizations against polio, diphtheria pertussis and tetanus.
As a result of his findings, Sweat told reporters yesterday that "voluntary counseling and testing ought to be considered a human right."
South African clinicians have noted that people are reluctant to obtain HIV testing services even when they are available for free. The problem most frequently cited is that there is little perceived benefit to getting a test. A negative result brings psychologically devastating news and the stigma of being infected with a deadly disease. Most important, there is a profound lack of treatment available to those who test positive.
Coates said that, in Kenya and Tanzania, there was no significant reluctance to take the test once it was offered. There are enormous benefits to knowing one's HIV status, Coates said. "It allows people to make plans for the future. People also want to protect their partners. And there are pharmaceuticals, outside of antiviral drugs, that can be used to avoid opportunistic infections."
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