United Press International - Wednesday, 12 July 2000
Michael Smith, UPI Science News

"With these new technologies, the numbers are really going to skyrocket," Elizabeth Marum, an AIDS consultant based in Malawi, said in a press conference called by the U.S. Agency for International Development.

Marum said expanded voluntary testing combined with counseling would avert many thousands of new HIV infections by allowing people to change risky behavior, whether they are HIV-positive or not.

The waiting time for older HIV tests -- up to two weeks in some cases -- deterred some people from getting tested, she said. Others got blood tested, but never returned for the results.

Testing centers in Malawi, she said, are now using two different same-day HIV tests, with a third available in case the first two give different results. The tests involve taking "just a drop of blood," she said, and they give results within hours.

The psychological effects of waiting can be devastating, said Dickiens Kolodo, the program administrator of the National Association of People Living With AIDS in Malawi. Malawi, a small country of fewer than 4 million people, has an HIV rate of nearly 19 percent among adults.

After he got tested, using old-style tests, "the waiting time was really tough," he said. "I was really scared."

And when he got a positive result, he said, "I thought my life was over; it was really hard for me to accept the results."

But, Kolondo said, the counselor at the test center helped him to find ways of living with the virus -- eating a balanced diet and taking regular exercise -- and to change his behavior to avoid infecting other people.

"Without that information, I don't think I would be here today."

Physician Patrick Osewe of Zimbabwe said the demand for testing and counseling can be enormous, if they are accessible, cheap, and associated with other services, such as treatment for sexually-transmitted diseases or tuberculosis.

Osewe said his country, assisted by USAID, has allocated $17 million over the next five years to expand the current network of nine clinics. "We think that's not enough," he said. But he said those clinics have seen a steady increase in demand since the first one opened last August.

In Malawi, Marum said, the two testing centers have seen a four- to five-fold increase in clients since they switched to same-day tests. She said the program now has $300,000 a year, but could use three times that.

Even in Uganda, where an extensive testing program has been in place for 10 years, she said, the yearly $1 million cost is only about a third of what's needed.

Studies released here earlier this week showed that testing can reduce risky behavior and avert HIV infections. The studies, by San Francisco researcher Thomas Coates and Baltimore scientist Michael Sweat, showed that averting one HIV infection costs about $250.

Sweat said (Wednesday) that it's difficult to estimate how much money is needed to expand testing through sub-Saharan Africa, which is the hardest-hit part of the world. "It would take a lot of money," he said, "but it would have a lot of impact."

"You are targeting your prevention dollars to people who are ready to make a change in their behavior," he said.
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