The Sunday News
Dr Cherifa, Sururu
In my last article, I ended up by challenging communities to help the Government of Zimbabwe achieve its targets of 90:90:90 by the year 2020.
With only two years left, we are obviously pressed on time to realise these targets. In this article we are going to concentrate on the first 90 of the 90:90:90 targets.
This 90 percent is an aspiration by the Ministry of Health and Child Care to have 90 percent of the population tested. I would therefore dwell more on testing services, the barriers and possible solutions.
Remember, in my previous article, I emphasised that, we all need to be screened for HIV and support the Government’s target of having 90 percent of the population tested. There are various services that are available for people to be tested.
I have had opportunities to go for outreaches in various communities. While the appetite to get tested is high, the issue of user fees seemed to act as a barrier for the majority of the people. One had to get their card stamped and for the clerks to do so they required payment.
The coming in of Results Based Funding (RBF) has resulted in most government clinics and hospitals scrapping HIV testing fees. The RBF, gives incentives for positive outcomes. In this case the attainment of 90 percent.
I have had comments and questions about the 90 percent testing target by 2020. The questions are more of anxiety about the feasibility of the nation achieving the 90 percent target given the fact that we are left with less than two years to reach 2020.
The statistics I have come from the National Health Strategy for Zimbabwe 2016 to 2020 which quotes 2014 statistics of 40.3 percent of men and 56 percent of women in the population were said to know their HIV status.
Chances are we have progressed but without innovation, we are unlikely to achieve the target. I will keep you informed as I get information.
However, there are still accessibility problems in most rural, farming and mining areas as people have to travel for long distances to access the testing services.
Outreaches on the other hand, especially the infrequent ones, tend to have large numbers of people coming for testing but these seem to be people who already know their HIV statuses.
In order to increase the number of people who are tested, we need to reach out to those who have not been tested and their partners in what is being termed Index testing.
Index testing is aimed at reaching out on those populations that are vulnerable and have limited access to HIV testing services.
The testing facilities also need to be client/patient centred. Patient centred services are built around the needs of the users of those services.
This gives opportunity for the communities to give input on what they feel need to be part of the services for them to use them effectively. It gives the community the voice to say “nothing for us without us”.
In closed communities there is involuntary disclosure in that those found to be HIV positive are singled out for further services and this may act as a hindrance for people to get tested.
A possible solution would be integration of testing services with other primary care services.
Our donors could be persuaded to support comprehensive primary health care services. All patients could be seen and screened for various diseases and appropriate treatments given without separation of HIV services from the rest of the services.
Vulnerable populations for example, prisoners, commercial sex workers, youths and adolescents, orphans, people living with physical and mental challenges, men who have sex with men and intravenous drug users may need innovative ways to reach out to them.
I am reliably informed that some innovative NGOs are now offering prevention services (pre-exposure prophylaxis and post-exposure prophylaxis) to commercial sex workers at night in areas where they ply their trade, offering convenience and minimal disruption to their daily activities.
These are now directed for comprehensive services at Khami Clinic where testing, prevention, treatment, monitoring and evaluation are on offer.
Prisoners, people with physical and mental disabilities as well as other isolated communities like informal mining settlements and closed religious groups may require scheduled visits in order to encourage them to get tested and access other services.
Youths and adolescents will need youth centred services with specially trained personnel. Paternalistic services may not be appropriate for this group.
Paternalistic services are services that are given to a group of people where the provider of the services assumes or advises according to what he feels would be in the best interest of the group according to his/her understanding.
This acts as a barrier to the group as what may be deemed “best” may not actually be in that group’s interests.
Upon testing there are two possibilities; an HIV negative or an HIV positive result.
Whatever the outcome you still need to get your partner tested. Some people, whose partners test HIV negative, go on to assume that they share the same HIV negative status.
It seems the story is the same for those who test HIV positive. There is an assumption that their partners would be positive.
The take home message is please, your HIV status is not your partner’s status. Let’s all get tested as individuals. It is possible to be HIV negative and for your partner to be HIV positive. This is HIV discordance statuses.
This means that one partner will be HIV positive and the other one HIV negative.
While doing preliminary work for a research project, it became apparent that negative partners are at high risk of HIV infection from their HIV positive partners.
A few HIV/Aids service providers have developed effective counseling messages for HIV-discordant couples. Sexual transmission of HIV accounts for the majority of the new cases that occur on a daily basis.
I await your feedback on what you know and believe about HIV discordance. For anyone tested for HIV and found to be HIV positive, the Ministry of Health and Child Care encourages a “test and treat approach” whereby one is immediately initiated on ART if they are ready.
It is hoped that with the 90:90:90 targets, majority of the people will heed the message and rush for testing.
As a primary care practitioner I believe in prevention rather than cure. If you are found to be HIV infected, there is room to prevent yourself from complications of HIV. Your effort to be tested and use the ‘test and treat’ approach will assist you by:
-Preserving your immunity
-Rebuilding your immunity
-Getting treatment early for infections that go with HIV such as TB and Hepatitis B and C.
-Enjoying a very long happy life just like that enjoyed by those without the virus.
-Curbing new HIV infections and protecting your loved ones.
-You could be a peer educator to others by offering practical solutions derived from real life experiences
Therefore, testing for HIV is a win-win situation for everyone. If you have not tested you should be making your way to get tested now. Until we meet again next week, may God bless you.
