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Lesotho takes HIV test on the road
Stephanie Nolen, theglobeandmail.com
2006-05-18

Teams of people will start going door-to-door across Lesotho next month to give everyone over the age of 12 the chance to have an on-the-spot HIV test.

They will approach people at the small stone houses where they live in the mountains, in the industrial zone factories where they stitch Gap sweaters, the churches where they go to mass and the mess halls where soldiers eat.

Lesotho is calling it 'Know Your Status,' an initiative of the government and the World Health Organization. Modelled on mass immunization campaigns such as those for polio, the HIV testing effort will cost 12.5-million (U.S.), most of which has yet to be raised from international donors, and run until the end of next year.

Organizers hope it will resolve one of the stickiest problems of responding to AIDS in Africa: the stigma and fear of the disease, which is still so great that many people don't get tested. Parents won't take sick children for HIV tests, and even doctors and nurses fail to suggest testing for the most obvious AIDS patient, out of a desire to protect "confidentiality"
or to avoid the implied shame.

The Lesotho campaign will rely on HIV tests that produce results in minutes.
These are cheap, about 2 a test, and use a finger-prick of blood rather than a syringe, so are more easily administered by lay people. Studies show that a third to half of people don't come back if they must collect their test results days or weeks later.

Community members will be asked to decide themselves how they wish to be tested -- whether, for instance, they want to be tested by residents of the village or by outsiders to preserve confidentiality. Key to the plan is the idea that no one will be offered testing without a full range of counselling, support, prevention and care options being available, whatever each person's diagnosis.

While the WHO speaks carefully of a "universal offer of testing," the reality is that people in AIDS organizations, clinics and on the streets in Lesotho use the words "routine," "mandatory" and "compulsory"
interchangeably. That produces a widespread feeling here that the testing will be, if not forced, then socially obligatory. In a tightly knit culture such as Lesotho's, the "encouragement" of a person of influence such as a chief or a priest -- or even a husband to his wife and children -- can amount to coercion, critics say.

"There is this kind of pie-in-the-sky notion that in the name of public health, you can test everyone door-to-door without serious consequences, even violent ones, for the individual," said Rachel Cohen, field co-ordinator for MSF (Doctors Without Borders) AIDS-treatment program in Lesotho.(Stephanie Nolen, theglobeandmail.com, 3 May 2006)

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