New rapid HIV test makes determining status easier

The University of Swaziland last week became the first site of a new rapid HIV testing procedure which allows a greater number of people to be tested. "The approach of 'Negative Determination' is designed to make it easy for those who may still be negative to find that out, without having to go to hospitals or special voluntary counselling and testing centres (VCT)," said Tizzy Maphalala, programme coordinator for the UN children's fund (UNICEF). The "Negative Determination" initiative was tested on about 1,000 new university students last week, using a pinprick technique to draw a drop of blood, which is then placed on a card that detects the presence of HIV antibodies. If a line fails to appear on the card within an hour, no antibodies exist and the person is deemed HIV-negative. "If a line does appear, this does not mean you are HIV-positive, because the card may register a false positive. What it means is that you must take a conventional blood test, following counselling at a VCT centre," said Alan Brody, UNICEF country representative for Swaziland. Effectiveness of the card test is rated at 99 percent, so the testing of 1,000 persons could yield 10 false positives. According to Brody, one reason Swaziland has the world's highest prevalence of HIV - an estimated 40 percent - is cumbersome blood testing procedures. "VCT is very costly in terms of human resources: we're short on nurses, we're short on doctors, and we're short of counsellors. The system is geared to finding HIV-positive people, and getting them counselling and treatment. People who simply want to know if they are negative have a hard time with queues and waits," Brody said. An example is the Family Life Association of Swaziland (FLAS) VCT centre, which also opened on campus last week and could only test 12 students a day. Counsellors pointed out that they would have to be on campus for nine months to test the university's 4,000 students. "At the same time, we are in demand in rural areas, which badly need mobile VCT centres," said a FLAS counsellor. Stigma remains the biggest obstacle facing testing centres. "If you go to a VCT facility to get tested, people see you and they think you've got HIV. Most people won't risk that stigma, and they live in ignorance of whether they are positive or negative," Hannie Dlamini, president of the Swaziland AIDS Support Organisation (SASO), a counselling service and support group for people living with HIV and AIDS, told PlusNews. Nevertheless, with the publicity over the country's worrying HIV prevalence figures, people who were unaware of their status assumed the worst. "It is important that we find a way to ease their minds," commented Phumelele Mthembu, a lecturer at the University of Swaziland and the campus' director of Health Information and Counselling. Students lined up for testing after a day and a half of lectures, films, plays and group discussions highlighting HIV and AIDS issues. "University students are already under a lot of pressure, and if they develop HIV they are hospitalised because of the symptoms, and it is then they learn they are HIV positive. This is tremendously stressful. Determining whether you are negative or not allows a student to take the next step. We can counsel them on nutrition and ARVS [antiretrovirals] if they learn they are HIV-positive," Thuli Mngadi, the national programme officer for the UN's Population Fund (UNFPA), told PlusNews. The campaign was launched after UNICEF approached the university. "We spoke to the university administration, and we pointed out that students are coming here at 18 or 19 - some are younger - and they leave three years later with a diploma in hand, but also with an invisible HIV infection. We asked, 'How can you let that happen?'" Incoming students who volunteered for the pinprick tests were given cards whose results only they could see. The students then slipped the cards into envelopes, wrote their sex and age, and dropped them in a box on their way out of the main auditorium. The number of students participating and a breakdown of results will be tabulated over the next few days. Health workers anticipate a nationwide rollout of the new test procedure.