Close the Gap: Don’t Fail Those Who Take the HIV Test


Geneva (Women’s Feature Service) – What is common between Stephen Watiti, 61, of Uganda, Lwento Mbulo, 23, of Zambia, and John Rock, 71, of Australia? Strangers to one another and living in different lands, they have unknowingly shared a bond for over two decades. Watiti, Mbuto and Rock have been living with HIV for over 20 years. The three met and shared their life stories during a session of the Twenty Plus Positive Dialogues at the 20th International AIDS Conference (AIDS 2014) held earlier this year in Melbourne, which I had attended as well.

Watiti is a medical doctor. He was shocked when he was diagnosed with HIV in 1993. But he carried on. He kept falling sick in the initial years till he started taking the anti-retroviral treatment (ART). His health improved, he got back to work and is now looking forward to attending his daughter’s graduation next year.

Mbulo is a young woman born with HIV. Thanks to timely information and ART, she is living a healthy life and has a daughter, who is not HIV-positive.

Rock has lived with HIV for over 25 years. He has been a key advocate for enhancing access to ART for people living with HIV (PLHIV).

Each of them was asked: “What keeps you going?” They were unanimous in acknowledging the wonders that ART has done for them, and how it has enabled them to live a productive life. Yet, it hasn’t been a smooth journey. In their different worlds and age brackets, Watiti, Mbulo and Rock have seen it all: painful discrimination, shortage of medicines, and loss of work opportunities to name a few of the trials.

Rock spoke from experience when he summed up his recommendations succinctly and urged: “Create an environment free of stigma; encourage people to test early; ensure better treatment; and keep people working.”

His words echo in my mind as I write this piece on World AIDS Day, the theme for which this year is “Close the Gap.”

One gap that must be closed immediately is in the area of HIV testing. According to UNAIDS, 19 million of the estimated 35 million PLHIV globally still do not know of their HIV status. Yet, when treatment is available, why don’t people test early on? The answer lies in the fact that stigma and discrimination still persist. People fear the risk of loss of confidentiality and its consequences. As per the guidelines, HIV testing should be voluntary, accompanied by counselling and the test result should be kept confidential.

Recently, I was in India to conduct the “National Workshop on Strengthening the World of Work and Private Sector Response,” organised in New Delhi by the National AIDS Control Organisation (NACO) and the International Labour Organization (ILO). In the preceding weeks, the ILO had assisted NACO to analyse the data related to testing of workers emerging from the National Strategic Management Information System (SMIS). Data coming from Integrated Testing and Counseling Centres was studied to gather insights into the HIV trend among the workforce.

Of the12 million people tested during 2013-14 (April 2013-March 2014), 7.9 million were workers. Of these, 0.82 million (1.7 per cent) tested positive. If there is one thing these figures reflect it is the fact that workplace intervention needs much more attention than it has received in the past. HIV positivity in the working population (1.7 per cent) as a whole is four to five times higher than the average adult HIV prevalence in India.

Officials coming from different state AIDS societies took note of the state-wise analysis and decided to focus on those economic sectors that seem to have higher HIV positivity. Dr Ashok Kumar, Deputy Director General, Strategic Information Management Unit and Basic Services, NACO, remarked, “We had this data but we had not analysed it from the workers’ perspective. This exercise has provided very useful insights, which will help us reposition our workplace initiatives.”

There is no denying that HIV programmes in India are working – 7.9 million workers opting to take an HIV test in a year certainly shows that. But then comes the vital question: is the route to treatment after testing clearly laid out and followed? The over-800,000 workers, who have tested positive, need to be linked to treatment. They must be able to start on ART as soon as possible, in accordance with the government guidelines.

Such timely treatment and upscaling HIV prevention with a focus on young women is also urgently required. According to UNAIDS, in 2013, almost 60 per cent of all new HIV infections among young people aged 15-24 occurred among adolescent girls and young women.

Watiti, Mbulo and Rock are living examples of how proper treatment can provide a chance to live. Their testimonies are also painful reminders of how stigma can rob a person’s self-worth and livelihood. PLHIV still find it difficult to retain their jobs or even secure one if their HIV status is disclosed. The unemployment rate for them is three times higher than the national average, as per the UNAIDS Gap Report 2014.

The coming year is going to be crucial. Leaders from around the world will finalise the Post-2015 Development Agenda. I hope the focus on HIV and AIDS is not lost and remains a priority in the Sustainable Development Goals, not only in health but as a cross-cutting issue in other areas as well, particularly employment. We need to do more than what we have done so far in the area of HIV and AIDS. We can’t afford to fail those who come forward to take an HIV test. As John Rock had shared during the session at Melbourne, ‘The past hasn’t been easy, but we must make it easy for others.’

(The writer is Senior Technical Specialist and Head, Communication, Training and Partnerships ILO AIDS, Geneva. The views expressed in this article are his own.)

((c) Women’s Feature Service)

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