adminTinomuda Chakanyuka
Sunday News Reporter
THE HIV self-testing programme set to kick off in Zimbabwe next month, on a pilot basis, has sparked a lot of debate amid a flurry of questions bordering on scepticism.
Age old fears, which at some point appeared to have been successfully allayed, have also been rekindled.
HIV self-testing is a process whereby a person who wants to know his or her HIV status collects a specimen, performs a test and interprets the test result in private.
A quick swab inside the mouth for saliva sample using the self-test kit allows a person, within 20 to 40 minutes, to know his/her status. One can also use blood samples to conduct the test.
The use of a saliva sample to self-test is what has, however, ignited questions and debate around the possibility of HIV being transmitted through saliva. Street or rather bus stop hypotheses would have it that, if one is able to detect the HIV virus in their saliva, then it may as well be possible for the virus to be passed on through exchange of saliva.
However, experts have allayed such fears, saying while it was possible to detect the HIV virus in saliva, the concentration of the virus in saliva is not sufficient for transmission to occur. The director of Aids and TB unit in the Ministry of Health and Child Care, Dr Owen Mugurungi, said people should thus not be afraid of kissing.
He explained that the HIV self-testing kits have been designed to detect the smallest quantity of the virus enabling one to test using their saliva where the virus is found in negligible concentration.
“Saliva does not contain the minimum concentration of the virus required for transmission to happen. The issue is you really need to exchange about five litres of saliva for transmission of HIV to occur, which is almost impossible even if people kiss for one hour. People must not be afraid of kissing.
“The self-test kits are made to detect the smallest quantity of HIV, whose concentration is not sufficient for transmission to happen. You need a certain number of virons for HIV transmission to occur and saliva does not have that number,” he said.
Dr Mugurungi said the only risk of HIV transmission through kissing is when both parties have bleeding sores in their mouths. Concerns have also been raised on the feasibility of HIV self-testing with critics saying the programme may lead to an upsurge in suicide, depression and domestic violence cases due to lack of effective and immediate counselling services before and after one gets to know their results.
Cases of people killing themselves after knowing their HIV status or that of their partners are common, giving credence to criticism of the HIV self-testing programme.
Last year a 43-year-old man from Nyanga, Alois Nyamagodo took his life allegedly after testing positive for the HIV virus. In January this year a member of the Zimbabwe National Army, Proud Tshuma, hanged himself 30 metres from his uncle’s house in Hwange allegedly after learning that his girlfriend of two weeks was taking antiretroviral drugs.
Nonetheless, Dr Mugurungi dismissed the criticism levelled against HIV self-testing and insisted the programme would be a success as other countries like Malawi had successfully implemented it. Dr Mugurungi said adequate measures would be put in place to ensure that individuals who would have tested positive after self-testing can immediately access counselling services. He said the introduction of the self-test should be done gradually and systematically.
“Like I have said before we are exploring a number of measures to ensure that people quickly and easily access counselling services after knowing their results. We want to set up a 24-hour toll free telephone line for those communities that have access to phones to get counselling services over the phone. For other remote communities who may not have easy access to phones we may then have counsellors stationed in each ward or village. The programme has been going on well in Malawi and that gives us confidence that we will not have problems here because our communities are more or less the same,” he said.
Zimbabwe was set to start piloting the HIV self-testing programme in February this year but the programme has been postponed to next month owing to logistical challenges. Over
375 000 are expected to take part in the study which follows a lower scale study that was successfully carried out in Harare and Shamva.
Dr Mugurungi said they were waiting for a “few things” to arrive into the country before the programme kicks off.
“We are waiting for a few things to arrive before we start. We wouldn’t want a situation where we kick-off and realise that we don’t have this and that. We want everything to be in place first then we can confidently take off.
“We are looking at commencing at the beginning of April,” said Dr Mugurungi without specifying the few things that were yet to arrive into the country.
The pilot project, also known as STAR, will run for the next two years before being rolled out at full scale.
The HIV self-testing programme comes in to offer more testing options for key population who cannot be reached by available testing approaches. Following the launch of the HIV self-testing programme in Zimbabwe, Malawi and Zambia in December last year in Harare, 750 000 people from the three countries are expected to participate.
This would be the biggest study ever to be done on HIV self-testing and results from the research are expected to influence global policy towards HIV self-testing. Statistics from the Ministry of Health and Child Care show that an estimated 1,2 million people are living with HIV in Zimbabwe. Only 66 percent of Zimbabweans have been tested and know their HIV status.
derick.khumalo