The Sunday News
Robin Muchetu Senior Reporter
THE Ministry of Health and Child Care is planning to roll out self-testing kits for HIV in an effort to encourage people to know their status and get treatment early, seeing that recent statistics show that of the 196 000 people who went for HIV tests since last year, 185 000 collected their results.
Government hopes the self-testing kits will encourage more people to know their HIV status.
Dr Owen Mugurungi, the director of the Aids and TB unit in the health ministry, was recently quoted as saying the ministry was undertaking an assessment before the introduction of the HIV self-testing kits.
“Before we introduce something new to the people, we run feasibility and acceptability tests as a way to check if the people are ready to receive the new product,” he said.
However, preliminary reports from the health ministry state that the self-test kits were widely accepted by people prompting Government to give the go-ahead to have them distributed.
HIV self-testing kits, also known as self-tests, allow people to test themselves without the aid of a healthcare provider. The kit allows an individual to test a blood or saliva sample and interpret the result within 20 to 40 minutes. What this means is that one can test for HIV the same way you are able to test for pregnancy at home. It also means that the role of counsellors at New Start Voluntary and Testing Centres will somehow be compromised.
The question that begs for an answer is how then will a person who tests positive accept or react to the results since they will probably be alone in their bathroom?
This procedure has been received fairly well in some sections of the society but Health Minister Dr David Parirenyatwa in a previous interview said Government would have to tread carefully to avoid any repercussions as HIV still had stigma attached to it.
“We want to remove the stigma associated with testing for HIV so people can test themselves but at the same time we want to do it gradually. Normally when we test you we have to counsel you so that you are ready for the results so if you self-test it means you are not ready for the results,” he said.
“To me the introduction of self-test kits needs to be done very systematically so that we do not have a situation where people are not counseled and it results in depression and people actually withdrawing so we need to balance it and do it appropriately.”
A Nyanga man who could not cope with testing positive for HIV recently took his own life by drinking a pesticide.
According to police, Allois Nyamangodo (43), of Mashava Village went to Mutare Provincial Hospital on 15 February to seek medical attention.
He was advised to go for HIV testing and the results came out positive prompting him to take his life.
Such incidents are testimony to the fact that the issue of HIV testing is still very sensitive and needs to be tackled accordingly.
Mrs Tariro Makanga Chikumbirike, the head of communication and media at SafAids, said HIV must be treated like any other illness and people must embrace self-testing.
“HIV is just like any other serious illness and it should be treated just like diabetes, hypertension and even cancer. We have to normalise this inequity in Zimbabwe and self-testing is actually a good move so that people know their status,” Mrs Makanga-Chikumbirike said.
She said there was still a lot of stigma and discrimination associated with HIV/Aids such that people were very skeptical about it and even the self-test kits yet it actually helped people in knowing their status. She also said there was a need to educate the general public on the kits before they are rolled out.
“The public needs to be educated on the kits so that when they are in circulation there is high uptake because if they just storm the market when people have little education they may not be useful. Campaigns should be done throughout the country too to give people a better understanding on what the kits are about,” she said.
The danger that seems to be looming is that since the Health Ministry seems to be “eliminating” the role of voluntary counselling and testing centres that are dotted around the country there may be an upsurge of people who contemplate suicide as they would not have been counselled.
An official from a Bulawayo-based organisation Samaritan-Befrienders that is involved in counselling said there was a risk of increased suicides.
“There is a high risk that those who test positive may be suicidal to a greater extent as they will not have immediate counselling based on their results. Pre-test and post-test counselling is very critical in dealing with HIV. We might just have a problem if this is not addressed,” the official who refused to be named for professional reasons said.
He said a number of people who come for counselling at Samaritan Befrienders usually come for extra sessions and would have been counselled before at New Start centres.
“We receive several people who will have tested positive for HIV and they come for extra sessions despite having been to New Start centres, which is a sign that there is a need to further augment counselling when one tests positive for HIV. If people then test at home who will be there to help them?” he asked.
He also questioned whether the test kits would come with some kind of instructions on what to do when one tests positive to reduce the probable risk of adverse reactions to results.
However, Mrs Makanga-Chikumbirike had a different opinion to the issue of suicide.
“If we say those that test positive for HIV tend to want to commit suicide are we saying those who test positive for equally life-threatening diseases such as hypertension are tempted to kill themselves when they hear their results? Why should people be suicidal because it is HIV?” she questioned.
She further said because Zimbabwe is not yet in a position to treat Aids like other illnesses, a lot of skepticism surrounds it. She said Zimbabwe should move into a zone where HIV is treated in the same manner as other diseases. Mrs Makanga-Chikumbirike said the self-test kits would play a complementary role to the efforts already made by the health ministry to get people to know their status and seek treatment.
“We have a tendency of throwing in spanners at Government efforts but what is vital is to make positive adjustments to Government initiatives and by so doing we will move forward in assisting each other,” she said.
A counsellor from Family Contact Services, Ms Ellita Mlilo, said the issue of self-tests was a dicey one as there was a general assumption that the people were well informed about HIV and Aids such that they were in a position to take home kits.
“The ministry of health has a general assumption that people are very knowledgeable about HIV to the extent of taking a self-test kit, people still need education and a push to get tested that is why there are things like Provider Initiated Testing and Counselling so that people know their status,” she said.
Ms Mlilo said if done at home people may have many unanswered questions especially when they are found to be living with the disease which can prompt one to commit suicide.
“Adolescents, for example, may not digest the news of being HIV positive well and they decide to end their lives as they will not have adequate information on their condition and also it is vital that people seek counselling before they are tested, making the role of VCT’s vital,” she said.
Ms Mlilo said the role of counselling in HIV testing is that it helps those that test either negative or positive to accept their condition and lead better lives but when you take out the counselling aspect and have people doing it at home, this may make them vulnerable.
A number of people interviewed by Sunday News indicated that they would be glad if the self-test kits were availed soon enough as visiting a testing centre was time consuming.
“If you visit a New Start centre you need an average of two hours before you get your results. The counselling sessions are too long and at times you have no time to be away from work for that long so at times we leave without collecting results. The self-test kits are the way to go,” said Mr Mongameli Dube.
He together with many others concurred that if the counselling processes were not too tedious people would be going to get tested at the VCT’s but the long time spent there deterred some.
“When you go to a voluntary testing site all you want to know is your result so delaying me for an hour or two will only make me more anxious so I appreciate the self-test kits and I have no long waiting period,” he said.
One gender activist, Mrs Sharon Nzou, had mixed feelings about the self-test kits.
“They are good and they are bad. Good in that for those that are intellectually and emotionally stable, they can handle whatever results come. They are also able to study and seek for medication when there is time. But for those that are not so strong, they might not handle it well. Some people need a lot of counselling from trained people to accept the results especially if positive. If left unaided, this could cause harm,” she said.
From a gender perspective, she said, men in general would have no problem with these kits as most of them have extra marital affairs and know they have put their lives at risk. So they are in a way better prepared to deal with the consequences of their actions.
She said women on another hand would not really embrace this self-test kit because of fear of the unknown. Some who have promiscuous husbands would rather not test themselves just in case they are positive.
However, the self-test kits, if used correctly, will have a positive impact on the HIV and Aids situation in the country as people will know their status and will possibly seek treatment on time.
