By Kassim Mohamed

Holding the holy Quran in her right hand, Amina adjusts her veil. She appears like any other ordinary woman on the streets of Nairobi but Amina has had a recent past full of emotional turmoil.home hiv test, hiv self test, home hiv kit

“A gang of 12 men raped me in turns on January 15, 2008. I passed out. That’s a day I’ll never forget in my entire life,” Amina bitterly says adjusting her veil.

Amina was born and brought up in Mogadishu but moved to Kenya along with her husband and five months old son in 2005. When life became too hard to cope in Nairobi, they relocated to Narok, a small town 200 km west of Nairobi.home hiv test, hiv self test, home hiv kit

With the help of relatives living abroad, the young family started a business: money came in and life appeared rosy. Kenya became a safe heaven and they considered it a home away from home but just until Kenya’s disputed election results were announced. In front of her maid and three-year old son, Amina was gang raped.home hiv test, hiv self test, home hiv kit

“My husband was not around, he left just before the Kenyan election for Mogadishu to see the other two wives and children back there. After the incident I didn’t inform him about what happened. I was too scared; he might consider me as an infidel. He doesn’t know up to now”.

In July 2008, the family left for Mogadishu and settled there for a while. However, the constant violence in the Horn of Africa country saw them back to Nairobi, Kenya.home hiv test, hiv self test, home hiv kit

She went for an HIV test in October 2009 and tested positive and because of the high levels of stigma attached to HIV/AIDS in her community, this 26 year old has not revealed her status to anybody. According to her, the Kenyan elections turned her world upside down.

Medical authorities at Nairobi Women Hospital say more than 300 women were raped during the post-election violence.home hiv test, hiv self test, home hiv kit

When Radio Netherlands informed Amina about the presence of the Chief Prosecutor of The International Criminal Court (ICC), Luis Moreno Ocampo in Nairobi, Amina sighed in relief. But she was soon heartbroken to learn that Moreno Ocampo has categorically stated after his first press briefing on Saturday that he will deal only with the “big fish” – those who bear the most responsibility in fanning the violencehome hiv test, hiv self test, home hiv kit

“I am here in Kenya illegally because my country is unstable. If the International Court can not heal my wounds and bring those who raped me and other women to book, I have little hope that local courts in Kenya will deliver me justice”.home hiv test, hiv self test, home hiv kit

Mr Moreno Ocampo is viewed by many Kenyans as the only hope to see those responsible for the infamous post-election crisis in the country punished. Moreno Ocampo has assured the public that Kenya’s case will serve as an example. He further asked the government of Kenya to protect witnesses who agree to give evidence.

Meanwhile, Amina says she will rather go back to Mogadishu than stay in Kenya during the 2012 general election.home hiv test, hiv self test, home hiv kit

According to Johns Hopkins researcher Charlotte Gaydos, DrPH, participants had no trouble distinguishing between positive and negative results.

Nearly all participants said they would “definitely or probably recommend” self-testing to a friend and would “probably or definitely” perform a test at home if it were available, Dr. Gaydos remarked in an article on WebMD. With further study, she went on to say, home testing for HIV might one day be as routine as pregnancy testing.home hiv test, hiv self test, home hiv kit

“Rapid HIV testing works by detecting antibodies against HIV, just like the kits used by health care workers for routine HIV testing,” says Larry Siebert, CEO of Chembio Diagnostics. Siebert went on to note that rapid, point-of-care (POC) tests such as those his company develops are single test cartridges, similar to pregnancy tests, that use a small sample of oral fluid or whole blood and deliver a visual result in approximately 20 minutes–and one may serve as a viable at-home HIV test.home hiv test, hiv self test, home hiv kit

“The hope for this test is that it can help identify those HIV-positive individuals who are unaware of their status and motivate them to seek immediate medical attention and early treatment,” says Siebert.

As per the law, VCT clinics or individuals will not be obliged to disclose the identities of those tested.

Though no official from the Ministry of Health was available to comment on the details of the report obtained by Khaleej Times, a press note said the country had adopted a system to deal with the disease.home hiv test, hiv self test, home hiv kit

“The UAE has adopted a draft system for dealing with reported cases and the actions taken to achieve prevention and co-existence of society members from getting affected,” said Dr Mahmoud Fikri, Executive Director for Health Policies at the ministry.

“The UAE submits its periodic report every two years to the United Nations in New York on a regular basis,” he said. In 2008, the UAE was criticised for failing to submit data to the UNAIDS Report on the global Aids epidemic.home hiv test, hiv self test, home hiv kit

The report points out that the UAE has one of the lowest reported HIV rates globally. “This could be attributed to deep-rooted religious, cultural, and social beliefs that help (prevent the) spread (of) the disease (e.g. homosexuality and prostitution); it is also partially attributed to the strong screening programmes that the UAE expatriates are mandated to go through prior to the issuance of their residency in the country,” it reads.home hiv test, hiv self test, home hiv kit

It adds that the exponential increase in the expatriate population had alerted authorities to increase spending on surveillance, prevention and treatment. As much as $17.6 million in public funding is spent on the disease, of which 82 per cent is dedicated to involuntary testing, it says.home hiv test, hiv self test, home hiv kit

As per the report, 49 UAE nationals were found HIV positive in 2009. Of these cases, 39 per cent and 35 per cent were discovered in Dubai and Abu Dhabi, respectively. It was, however, agreed in the report that the reported cases may be underestimated since an undetermined number of nationals prefer to test HIV status and seek care, treatment and support service
outside the country for fear of stigma and discrimination.home hiv test, hiv self test, home hiv kit

In contrast, the number of HIV positive cases among expatriates has been increasing with the increase in the number of foreign workers employed in the country, it said, adding that national reports do not reflect numbers since expatriates are repatriated if they test positive.

“The logic for repatriation of expats diagnosed with the disease relates to the fear that they may develop resistance should treatment be initiated in the UAE and discontinued upon return to home country,” reads the report.home hiv test, hiv self test, home hiv kit

The report also agrees that the weakest element in the UAE’s response to the disease was its monitoring and evaluation system. It also points out the need to conduct behavioural studies, monitor modes of transmission and disseminate education on the disease among school children and youth.home hiv test, hiv self test, home hiv kit

“I came here from North Kivu Province with my husband and our two children. When I got pregnant, the doctor asked me to do an HIV test. I thought it was not necessary. I was married for years, why would I be HIV-positive?

“When the results came a few days later I was shocked. I didn’t know much about HIV other than if you have it, you are going to die. I went back home and told my husband about my status. He was furious, we had a fight and after that he left. I have no idea where he is now.home hiv test, hiv self test, home hiv kit

“All I know is that I gave birth to our third child two days ago and he doesn’t even know about it. I wonder if he even cares. If he did, he would have looked for the other two children; he never has since the day he left us.

“Since finding out my HIV status, I enrolled in the counselling programme in the camp. I go there once a week. It helped, I think. At least now I know I am not the only person going through this and that I should not be ashamed of it.home hiv test, hiv self test, home hiv kit

“If you are HIV-positive you are stigmatised in your community. I lost many friends. People just don’t talk to me, and they don’t care that maybe it is not even my fault if I got sick. I am very angry as I still cannot understand how that could happen. My only partner was my husband.

“The doctors told me to follow the prevention of mother-to-child-transmission programme for my new-born. In six months, we will know if he is HIV-positive as well or not.home hiv test, hiv self test, home hiv kit

“This is the only thing I can do to maybe save my son’s life. I am taking [life-prolonging antiretroviral drugs] ARVs myself. I need to be as healthy as possible. If I were alone, I would probably let myself die, but I have to do this for my children.”home hiv test, hiv self test, home hiv kit

About half of all Kenyan TB patients are co-infected with HIV, so HIV testing has become routine in TB clinics, with 83 percent of TB patients also screened for HIV. home hiv test, hiv self test, home hiv kit

“We have encouraged health facilities to not only test TB patients for HIV but also to reach out to their partners to bring them along for counselling and testing for HIV together,” Joseph Sitienei, the head of leprosy, TB and lung disease at the Ministry of Health, told IRIN/PlusNews. “The uptake of TB screening across the country has been impressive; it provides the best avenue to encourage partners to test together for HIV.” home hiv test, hiv self test, home hiv kit

According to the latest Kenya AIDS Indicator Survey, 10 percent of married couples have at least one HIV-infected person, but just 22 percent of couples know the HIV status of their sexual partners. An estimated 44 percent of new HIV infections in Kenya occur among married or cohabiting couples; HIV discordance is also a problem, with 6 percent of couples – or 344,000 – having at least one HIV-positive partner. home hiv test, hiv self test, home hiv kit

In many African countries where multiple concurrent partnerships are blamed for high HIV incidence, couples counselling is now being recommended. Experts suggest reaching couples through partner testing in home- and facility-based treatment and care programmes, the integration of partner testing into provider-initiated testing and counselling and prevention of mother-to-child transmission programmes, as well as door-to-door testing and bio-medical interventions such as medical male circumcision. home hiv test, hiv self test, home hiv kit

“[Couples counselling and testing] does not only help them know their status but it provides an opportunity to identify discordant couples and then helping them to know better how to manage themselves,” said Andrew Suleh, medical superintendent of Mbagathi District Hospital, one of the model sites for TB diagnosis/screening and couples counselling and testing in the capital, Nairobi. “Safe sex and reducing risky sexual behaviour is heavily emphasized… those who test positive are made to appreciate the need for positive living.” home hiv test, hiv self test, home hiv kit

While more men than women have the disease, female numbers continue to grow.
“One in four people living with HIV are women,” said Holly Jordt, a nurse at Family Planning. “It’s time for women to get tested.”
Susan said she never expected to find herself as one of these statistics.home hiv test, hiv self test, home hiv kit

Her story begins in Montana where she grew up. Susan, now 42, said she left home at 18, fell in love, got married and had a baby. It had the makings of a feel-good Hallmark movie until the plot took a terrible turn.
Susan was alone at home with her 5-month-old baby when a knock at the door changed her life forever.
A representative from the health department told her that she had been exposed to HIV.home hiv test, hiv self test, home hiv kit

“I said, ‘What’s that?’” she recalls. “They said ‘That’s the virus that causes AIDS.’ I said, ‘You’ve got the wrong door.’ It took a lot of convincing for me to get tested.”
She argued that she wasn’t gay and didn’t do drugs. Women, especially those in a committed relationship, weren’t considered at risk in 1991 when she was 23.home hiv test, hiv self test, home hiv kit

Health department officials didn’t disclose who provided her name but her husband, who died in 1994, later told her that he was the person who sent the health officials to her door.
When she tested positive, Susan was terrified for her tiny daughter who had been born prematurely weighing just three pounds, 12 ounces. She had to wait two weeks for her daughter’s results.home hiv test, hiv self test, home hiv kit

“I thought I had killed her,” she said. “That was the longest two weeks of my life. I couldn’t even set her down.’”
Two weeks later, Susan got the results showing that her baby had a 90 percent chance of not being infected. She had to wait three more years to receive a clean bill of health for her child.
At the time, she was consumed with anger toward her husband. Susan had trusted him completely and now she faced a potential death sentence.home hiv test, hiv self test, home hiv kit

“I needed to blame someone,” she said.
Since then, Susan has come to realize that he did not knowingly infect her with the virus. Ignorance of the threat of the virus killed him and condemned Susan to a lifetime of battling to stay alive via an ever-changing cocktail of drugs.
“You’re responsible for your own health,” she said. “With education, I would have realized how susceptible I was as a woman.”home hiv test, hiv self test, home hiv kit

Just six months into her fight, she decided to risk her privacy in the interest of making a difference.
She talks to young people in many settings.
“If I can save one life, it’s worth it,” she said. “It’s easy to avoid.”
For her courage, Susan was honored with the Governor’s Award for HIV Awareness in 2008. She speaks simply but directly about how a person does and does not acquire the disease.home hiv test, hiv self test, home hiv kit

She delineates the four bodily fluids of HIV virus transmission — blood, semen, vaginal secretions and breast milk — and the routes into the body. Her audience learns that any activity that exposes a person to these fluids put them at risk for an HIV infection.
She underscores that saliva and urine do not transmit the disease.
Susan finds some people refuse to believe that they won’t become HIV-positive from casual contact. They also blame the victims for becoming infected.home hiv test, hiv self test, home hiv kit

“There’s a certain part of society that can’t be taught — they think you must have done something to have this,” Susan said. “My family is like that.”
Her partner of 13 years, who was a friend first, provides proof that protected sex works. She points out that he has not become positive from casual contact living in close quarters with her.
“He feels the stigma as much as I do,” she said. “It’s scary — they’re afraid of the unknown. I never knew what prejudice was until I got this disease.”home hiv test, hiv self test, home hiv kit

In spite of all the publicity about HIV in the last 18 years, Susan said she hasn’t seen the stigma decrease. She hopes at least that more people use condoms and both get tested, ideally before embarking on an intimate relationship.
After her talks, Susan said some confide in her that they had unprotected sex, often under the influence of alcohol, and ask her advice. She encourages them to get an HIV test and take command of their health and safety.
“For women and girls, it’s easy to avoid if you’re empowered,” she said. “If you can’t say no, make sure you use a condom.”home hiv test, hiv self test, home hiv kit

Judging from her own daughter and her friends, Susan said the young still feel invincible even from AIDS. She added that young and old alike disconnect from sexually transmitted diseases with permanent birth control in place.
“You can get pregnant a few days a month,” she said. “You can get a STD any day of the month.”
Statistics of risky behavior show many young people don’t practice abstinence or safe sex. A 2009 survey of Montana youths in grades 9 through 12 revealed an average of 48 percent had sex; 68 percent used a condom during their last encounter.home hiv test, hiv self test, home hiv kit

Since 1985, almost 600 people have been diagnosed with HIV in Montana. In 2009, another 31 Montanans got the devastating news that they were HIV-positive.
This number was almost 30 percent higher than 2008. Deaths since 1985 have numbered 382.
Susan has been fortunate in recent years to find a combination of five drugs that have kept her healthy enough to finish schooling and work at a job. It was much tougher in the earlier days when she took up to 25 pills a day with terrible side effects.home hiv test, hiv self test, home hiv kit

“Most of the ’90s, I wasn’t able to work,” she said.
She has fought off bouts of pneumonia, shingles, thrush and yeast infections. Her blood is tested every three months to monitor when the virus becomes resistant to her drugs.
When that happens, she starts a new combination that makes her violently ill during the first weeks. Susan always faces the temptation to stop the drugs since she feels better off them.home hiv test, hiv self test, home hiv kit

Still, she feels gratitude that she lived to raise her daughter and remains in relatively good health with improvements in therapy over the years.
“The meds have made leaps and bounds,” she said. “It’s amazing what they’ve done. I never thought I would live this long.”
Susan worries that her appearance of good health might diminish her impact with the students. She makes the point that AIDS remains a fatal disease.home hiv test, hiv self test, home hiv kit

“I don’t want them to think you just take a pill. Side effects can be very debilitating,” she said. “It’s a strict regime. If you miss a dose you risk mutation of the drug.”
The financial burden can be substantial. Susan’s drugs cost $2,500 a month and cause numerous side effects over time.
Some people get diabetes and clogged arteries or suffer body changes such as fat accumulating as a buffalo hump on men or around the middle on women.home hiv test, hiv self test, home hiv kit

“It’s a less-than-ideal way to live,” she said. “I hope they [students] go home and share this with their parents and it starts a conversation. Maybe they’ll think ‘I should get tested.’”home hiv test

In Taiwan, the end of the Chinese New Year was marked by blasting firecrackers and jumping into water to pray for good fortune.
In this century-old tradition, volunteers would dress up as Han Dan, the god of wealth, and have other people throw fire crackers at them.home hiv test, hiv self test, home hiv kit
The volunteers must endure the pain to help the town get rid of evil spirits and to usher in better fortunes for the year ahead.
Some are hired to take on the painful role, and the wounded role-players are awarded handsome payments and gold medals for their courage and strength.
These brave volunteers arm themselves with helmets, masks, gloves and more in order to endure two-minutes of firecracker-bombing.home hiv test, hiv self test, home hiv kit
Ironically the more serious injuries resulted from a pyrotechnic show in central Taiwan’s Chiayi City, where something went wrong with the fireworks and 33 people were wounded.

And in Or Yehuda, a city situated adjacent to Israel’s Ben Gurion International Airport, residents fell in line at a distribution center for their new gas masks.home hiv test, hiv self test, home hiv kit
Most would wonder if this is a case of national emergency, but to most Israelis, it’s quite a routine procedure.
It is part of a nationwide project which was decided a year ago by the Israeli Defense Ministry.
The Israeli Army aims to equip the entire population with new gas masks to replace old ones within a three-year period.
Some Israelis are fearful of attacks from other countries, and most would rather be safe than sorry, so they were all grateful recipients of the new gear.home hiv test, hiv self test, home hiv kit
The Israeli Army’s Home Front Command reported that in the event of an emergency, they are ready to distribute the kits to the entire nation within weeks.

This lack of specifics was reminiscent of the head-in-the-sand speeches delivered by the administration of his predecessor Thabo Mbeki. Despite recent progress in some facets of the national HIV program and successfully reversing the domestic course (and discourse) on HIV/AIDS since taking office, the administration needs to continue to lower the rate of new infections and find the human and financial resources to treat millions of infected South Africans.home hiv test, hiv self test, home hiv kit

A Decade of Ignominy
When Mandela left Robben Island twenty years ago, HIV prevalence in South Africa was just over 4 percent and life expectancy was sixty years. As president of South Africa, Mandela instituted progressive HIV policies, including a comprehensive “AIDS Plan,” but a failure of leadership and lack of national and provincial capacity undermined efforts. By the late 1990s, progressive policy was replaced by nearly a decade of political missteps, controversies, misinformation, and hundreds of thousands of preventable deaths. These included a costly, flawed play–which never opened–intended to educate the public about HIV/AIDS, promotion by government officials of a toxic industrial solvent to treat HIV, and refusal to provide infected pregnant mothers with AZT and nevirapine (proven anti-HIV drugs) to prevent transmission of HIV to newborns. home hiv test, hiv self test, home hiv kit

The era culminated with President Mbeki’s public questioning of HIV/AIDS science; his health minister’s promotion of garlic, beetroot, and lemons instead of anti-HIV drugs; and government refusal to provide HIV treatment to sick patients until 2004, when threatened by legal action from activists such as the Treatment Action Campaign.home hiv test, hiv self test, home hiv kit

Looking Ahead
South Africa is the front line in the global battle against HIV, the regional epicenter of tuberculosis, and the largest beneficiary of U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) funds–approximately $1.5 billion to date. And despite the fact that at its peak in 2001 more than 20 percent of South African adults were infected with HIV and life expectancy fell to forty-one years, the government for years obfuscated, obstructed, and dithered about the domestic HIV crisis. As a result, many died or were needlessly infected. Nonetheless, a turnaround has been slowly building since 2004, and in its first year the new administration has rolled out more progressive policies and aggressive programs.home hiv test, hiv self test, home hiv kit

Making the announcement early this year national government spokesperson Themba Maseko explained that it was in line with the plan to see all South Africans tested for HIV and Aids.
“All public health facilities, fixed and mobile, will be equipped to offer HIV testing and to provide antiretroviral therapy (ART),” he said at the time.home hiv test, hiv self test, home hiv kit

But stakeholders and Aids activists said the programme could create confusion and cause people, in particular those from rural areas, to stay away from clinics for fear of being told that they were HIV positive.
Although recognising the benefits of the actual testing itself, the National Association of People Living with HIV and Aids (Napwa) said the danger was implementing the programme at a time when people did not know their options.
“We support the programme but we are wary of the fact that our people on the ground and in rural areas won’t know their human rights, and will allow themselves to be tested even if they do not want to be,” the organisation’s national director Nkululeko Nxesi said.home hiv test, hiv self test, home hiv kit

He explained that the programme had an opt-out option, where people could refuse to be tested. “Unless government quickly scales up the human rights education that should have preceded this, it could create more panic and havoc than good,” he said.
Mthatha Olive Leaf Foundation co-ordinator Ayanda Nqiwa, whose work puts her in the middle of the rural, uneducated and poverty- stricken Nyandeni folk, said the programme would promote discrimination and would keep people away from clinics.home hiv test, hiv self test, home hiv kit

She said: “The mere mention of the test will scare them off. They will not think to ask if they can get treated without being tested, and so rather than risk the negative results they will stay away, get worse and die at home.”
The Democratic Alliance’s provincial health spokesperson Pine Pienaar agreed that the HTC had good intentions, but said the policies around it were unclear. “To avoid confusion there should be boards at all centres explaining that they could opt out,” he said.home hiv test, hiv self test, home hiv kit

Buffalo City’s South African National Civic Organisation’s spokesperson, Bantwini Deliwe, said the test should be offered only to those who would benefit from knowing their status.
Rev Lulama Ntshingwa of the Eastern Cape Aids Council said the HTC campaign would encourage people to disclose their status and would help those who are negative to stay that way. — By NTANDO MAKHUBU, Health Reporter, ntandom@dispatch.co.zahome hiv test, hiv self test, home hiv kit

“The target of the HCT (HIV counselling and testing) campaign is to test up to 15 million people by June 2011,” cabinet spokesman Themba Maseko told journalists.
“All public health facilities, fixed and mobile, will be equipped to offer HIV testing and to provide ART’s (antiretroviral therapy).”home hiv test, hiv self test, home hiv kit

An estimated 5.7 million of 48 million South Africans are HIV positive, according to the UN AIDS agency, with South Africa now boasting the world’s largest treatment programme after years of failure to roll out life-saving drugs.
The new plan, to meet a target of providing anti-AIDS drugs to 80 percent of South Africans in need of treatment, will be launched on April 15.home hiv test, hiv self test, home hiv kit

Today, despite the progress made in research, about 60 per cent of HIV-infected patients are still not treated.

“I’m very furious,” said the 2008 Nobel Prize of Medicine winner. “I’m furious also to see that people are discriminated (against).”

The self-described “scientist-activist” also lamented that “we will not reach the (global) objective of universal access to treatment by 2010″.

In Singapore’s case, “the stigma, the fact that they (people) have to pay everything, it’s the worst condition for stimulating people to be tested and treated”, said Professor Barre-Sinoussi.home hiv test, hiv self test, home hiv kit

Free testing, free treatment

Prof Barre-Sinoussi, who was at the Biopolis last week to share her latest research findings on natural protection against Aids, said she was initially impressed with Singapore’s “wonderful facilities”. “Then, I rebalanced my positive view,” she said.

Singapore’s proportion of new HIV cases – there were 456 in 2008 and 423 in 2007 – to the general population is “a little more” compared to France, said the research director. Throw in “stigma and discrimination” – the No 1 barrier to tackling HIV/Aids – and the figures are probably under-reported, she said.home hiv test, hiv self test, home hiv kit

“Coming from a country (France) where everything is free, this is difficult to accept,” she added.

“HIV, like cancer, is a very severe deadly disease and should be considered as 100 per cent free for patients,” she stressed.

When contacted, the Ministry of Health (MOH) agreed that the stigma of HIV was “still prevalent” here.

It is working to encourage greater acceptance of people with HIV. home hiv test, hiv self test, home hiv kit

But MOH pointed out that unlike France, where the state-funded healthcare system “means a higher tax burden”, Singapore’s approach of “heavy Government subsidies and co-payment” allowed for affordable healthcare without heavy taxes.

“Like all other patients, HIV/Aids patients have access to subsidised … care,” said MOH. Patients here can use Medisave and Medifund.

HIV prevalance among Singapore residents is “similar” to other developed nations, said MOH. home hiv test, hiv self test, home hiv kit

It was about 0.1 to 0.2 per cent last year, while UNAIDS 2008 figures showed France’s HIV prevalence at 0.4 per cent.

MOH said it had “expected” that more HIV-infected people would be discovered as MOH encouraged testing. Over half of 2008’s new cases had late-stage HIV infection.

But what is the cost to the economy when young people who should be working die, asked Prof Barre-Sinoussi, suggesting that Singapore conduct studies to determine the cost. “The answer (in similar studies) was clearly in favour of access to free treatment,” she said.

Action for Aids’ executive director Lionel Lee said free treatment subjects the healthcare system to abuses and “may not translate to long-term economic benefits” because of the side effects of HIV medication.home hiv test, hiv self test, home hiv kit

At an HIV research meeting this week, boffins from the World Health Organisation revived a mathematical model that shows that if we test everyone in Africa for HIV once a year and give everyone who tests positive expensive drugs right away and for the rest of their lives, we’ll wipe out new HIV infections within seven years. That’s because HIV is passed on most easily when there’s lots of virus in the infected person’s blood and body fluids. Antiretroviral medicines cut the “viral load” (the amount of virus in the body), so they make it more difficult to pass on HIV. Ergo, more treatment means fewer new infections.home hiv test, hiv self test, home hiv kit

Sadly, it’s not that simple. For one thing, HIV is most infectious in the few months after a person is first infected. Even if everyone got tested annually, we’d miss most of these new infections. Second, people’s viral load spikes upwards if they get another sexually transmitted infection (STI), or if they stop taking their medicine because the clinic runs out of stock, the meds make them feel sick, or they went on a three-day bender and forgot their pills. Interrupting treatment also allows the virus to develop resistance to drugs, and that leads to more spikes in viral load. Most importantly, antiretrovirals keep you alive and well enough to be out there meeting new sex partners. That’s a good thing, obviously, but it also means that people who have HIV are going to have more chances to pass it on during those times when their viral load is spiky.home hiv test, hiv self test, home hiv kit

There’s more. In countries like the UK where treatment has been available for over a decade, Aids has virtually disappeared. HIV, unfortunately, has not. A few years after antiretrovirals became widely available, new infections among gay men in the UK began to rise. We’ve seen the same thing in Australia, the United States and practically everywhere else we have data. One reason for that is that gay men use condoms less now than they did when HIV = Aids = a horrible death. Now, though, HIV = a pill every day. Boring, but not the end of the world, unless you’re the taxpayer picking up the tab for it or the epidemiologist worrying that drug-resistant strains of HIV will reignite Aids.home hiv test, hiv self test, home hiv kit

On top of that, many people assume that if the person they’re having sex with is infected, they’ll be on meds and so not very infectious. Which may be true if they’re not in that early peak of infectiousness, have taken all their pills diligently, and don’t have another STI. Though since condom use is dropping across the board, other STI rates are soaring. In short, more people living with HIV, combined with more unprotected sex is outweighing the effects of lower viral load in places where the population is well informed, HIV testing is actively promoted, and treatment has been free and universally available. But in Africa it will be different.home hiv test, hiv self test, home hiv kit

Our computer model assumes every African will get tested for HIV every year, everyone who tests positive will start taking antiretrovirals immediately and 98 out of 100 will never miss a dose. On top of that, though gay men in rich countries use condoms far less now than they did before we had antiretrovirals, we assume that heterosexuals in Africa are going to use them more once the most visible and frightening face of Aids disappears.home hiv test, hiv self test, home hiv kit

On the strength of this model, which bears as much relation to reality as an MP’s expense claim, we are going to hail expanded HIV treatment in Africa as the new answer to prevention. A triumph of optimism over common sense.home hiv test, hiv self test, home hiv kit

Facts – Screening Blood for HIV

    - On March 2, 1985, the U.S. Food and Drug Administration (FDA) approved
      the first-ever diagnostic test to screen blood donors for antibodies to
      HIV. This first test was developed by Abbott.
    - The first test to screen donors for exposure to the virus took nine
      months of around-the-clock work by dozens of Abbott scientists to
      develop.
    - U.S. Health and Human Services (HHS) Secretary Margaret Heckler
      announced FDA approval
      (http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/HIVand
      AIDSActivities/ucm151074.htm) of the first test at a news conference
      in Washington, D.C. The screening test was immediately adopted by the.
      American Red Cross (http://www.redcross.org/) and other blood
      organizations.home hiv test, hiv self test, home hiv kit

Facts – HIV

    - In 1985, the virus was widely called HTLV-III
      (http://www.thebody.com/Forums/AIDS/SafeSex/Archive/origins/Q8777.html).
      The International Committee on Taxonomy of Viruses
      (http://www.ictvonline.org/index.asp?bhcp=1) changed the name to Human
      Immunodeficiency Virus (HIV) in May of 1986.home hiv test, hiv self test, home hiv kit
    - The Centers for Disease Control and Prevention (CDC)
      (http://www.cdc.gov/hiv/topics/surveillance/index.htm) estimates that
      there are 56,000 new cases of HIV in the United States annually, down
      from an estimated peak of 130,000 new cases in the mid-1980s.
    - In 2008, UNAIDS (http://www.unaids.org/en/default.asp) estimated
      that 2.7 million people throughout the world are newly infected with
      HIV each year, primarily in Sub-Saharan Africa.
    - Women account for 50 percent of adults living with HIV globally.home hiv test, hiv self test, home hiv kit

This is Regan Hofmann, who has been living with HIV for 14 years.

Hofmann grew up in Princeton, N.J., and graduated from the private, co-ed Princeton Day School and Trinity College in Hartford, CT. Soon after, she married and moved to Atlanta, GA, with her husband, where she was hoping to find a writing job. Then the marriage failed.home hiv test, hiv self test, home hiv kit

After her divorce at 28, Hofmann started dating a man.

“I had sex without a condom twice,” she says.

She never imagined her boyfriend was HIV positive.

“He seemed so clean and safe. He had a nice family. He sang to me and let me drive the boat, with his arms wrapped protectively around my shoulders, when we went waterskiing,” she said.home hiv test, hiv self test, home hiv kit

He was the kind of man she’d bring home to her family. She didn’t know that he had a sore on his leg that would not heal. He did not know the implications of his sore.

But Hofmann knew that shortly after unprotected sex – when she and her boyfriend were in the process of breaking up – she had a swollen lymph node in her upper leg. She went to the doctor, who gave her an HIV test.

He gave her the results with these words: “I don’t know how to tell you this, so I am just going to tell you. Your blood work shows that you are HIV-positive. I am so sorry.”home hiv test, hiv self test, home hiv kit

Back then, Hofmann considered HIV a death sentence. But instead of “planning for my impending death and a graceful demise with a service of song, dance, drink, and celebration,” she is now “completely and thankfully healthy.”

She estimates that she has consumed over 48,000 pills over the past 14 years – mostly protease-inhibitors, which have kept the virus at bay. Today, her regime is down to three pills a day.home hiv test, hiv self test, home hiv kit

She has never had a negative reaction to the drugs or suffered ill effects from HIV. She sums up her good health by saying, quite calmly, “You can have a normal life with HIV.”

Her ex-boyfriend died five years ago from complications of AIDS. Hofmann says he didn’t know he had the virus or that he was passing it along to her. She says he was not “a gift-giver” – a person who knowingly and intentionally passes along HIV.home hiv test, hiv self test, home hiv kit

Hofmann tells her story in an exceptionally well-written book, I Have Something to Tell You. It reads like a novel and is selling well. (”Even my plumber has read it,” she confides.)

She says that writing the book – and more importantly, telling the truth about life with HIV – was “a new beginning.” It led her to become an activist and gave her life a mission: “to tell everyone in the world willing to listen how to prevent getting HIV, how to get tested, how to get proper treatment in order to live, and how to change the insulting stigma so often associated with the disease.”home hiv test, hiv self test, home hiv kit

Hofmann fulfills her mission in several ways: She is editor-in-chief of POZ, a national magazine for people living with HIV and AIDS. And she recently joined the board of directors of AmfAR, The Foundation for AIDS research, by far the most important organization of its kind in the U.S.home hiv test, hiv self test, home hiv kit

Despite years of hard work, Hofmann worries she’s not doing enough. She’s deeply concerned about the current state of the pandemic.

“The world and America are suffering from ‘AIDS apathy,’ ” she says.

The numbers she reels off are proof that there is no reason for complacency: Every nine seconds, someone in the world is diagnosed with HIV; 33.4 million people are estimated to be living with the virus, and 25 million have died from AIDS to date. The numbers, she says, “make the HIV/AIDS pandemic far and away the worst medical catastrophe to have visited humankind since the Black Death struck Europe in the 14th century.”home hiv test, hiv self test, home hiv kit

Hofmann is concerned about the disease’s effect on women, particularly African-American women. AIDS is the number-one killer of women between the ages of 15 and 44 worldwide; in the U.S., 27 percent of people infected with HIV are female and disproportionately African-American (although the good news is that African-American men are more likely to get tested than other racial and ethnic groups).home hiv test, hiv self test, home hiv kit

“Women are not in a position of power when it comes to sex,” says Hofmann, when asked about the discrepancy in numbers. She talks of women she has seen in her travels who are caught up in the sex trade.

“They have sex to make money to buy food to feed their children. They make more money if they have sex without a condom – almost five times more than if they have sex with a man who uses one,” she says.home hiv test, hiv self test, home hiv kit

She sees the development and use of microbicides as one of the most promising preventive interventions to emerge over the past decade. She says they are an effective weapon against HIV/AIDS for young girls forced into early marriage in sub-Sahara Africa and other parts of the developing world. These young women are often infected by their older husbands, who have had unprotected sex with HIV-positive prostitutes.home hiv test, hiv self test, home hiv kit

Hofmann’s activist work has taken her as far away as Vietnam and as near as Greenwich, CT. She remembers a visit to a Greenwich middle school, when a supervisor warned her not to answer any questions about sex, and a 12-year-old male student asked her if it was safe to keep a condom in his wallet. Hoffman plowed ahead and answered him: “Just make sure that you check the expiration date on the condom and don’t use it if it has expired.” The student shot back: “Oh, I’ll get to it long before it expires.”home hiv test, hiv self test, home hiv kit

Hofmann is frustrated with Americans’ views about sexuality education. She quotes her mother: “Condoms are like Band-Aids and gardening gloves: they’re just a protective device.” She wishes that every parent and teacher would use this wise analogy.

She has wonderful ideas for HIV/AIDS prevention. She’d like to see HIV-prevention ads run during halftime of the 2011 Super Bowl.home hiv test, hiv self test, home hiv kit

“Why can’t we discuss how football and the leadership idolatry it creates be leveraged to help educate American youth about sexual health?” she asks. “Give us one cool player from each team mentioning the use of ‘safe sex,’ and maybe a cheerleader or two, and that should get the nation’s attention!”

She favors teaching young people decision-making skills in sex ed, so that in the heat of the moment, they will have the skills they need to discuss using condoms or not having sex.home hiv test, hiv self test, home hiv kit

“Courses have to be much more explicit than most presently are, and young people need to practice putting condoms over rubber penises in the classroom. They also need to learn to put them on in the dark,” says Hofmann.

“Sex isn’t just kissing or intercourse; it’s everything in between,” she adds.

For Regan Hofmann – whose story has given her a global vision and global work – preventing HIV is about self-esteem, human rights, and personal dignity. She will spend her life doing everything in her power to removing its stigma and stop the virus from infecting more women and men.home hiv test, hiv self test, home hiv kit

That is what Hofmann has to tell us.

Will we listen?

On World AIDS day of last year Zuma stated, “We have no choice but to deploy every effort, mobilise every resource, and utilise every skill that our nation possesses, to ensure that we prevail in this struggle for the health and prosperity of our nation The amount of resources dedicated to prevention, treatment and care [for HIV and TB] has increased…but it is not enough. Much more needs to be done. We need extraordinary measures to reverse the trends we are seeing in the health profile of our people.”home hiv test, hiv self test, home hiv kit

Despite the poverty of the area, the Khayelitsha programme is a place where extraordinary measures have been implemented for more than a decade. It is an important model for demonstrating the feasibility of different strategies to achieve the targets set forth in the National Strategic Plan (NSP) for HIV/AIDS and Sexually Transmitted Infections (STIs), including achieving “universal coverage” of antiretrovirals, by 2011- all of which would have been impossible without the relentless combined efforts of Khayelitsha residents, the Treatment Action Campaign, Médecins Sans Frontières, the Provincial Government of the Western Cape, the City of Cape Town, the Universities of Cape Town and Stellenbosch, and many others.home hiv test, hiv self test, home hiv kit

Khayelitsha was the first in South Africa to provide ARVs in public sector clinics and its initial success contributed to the paradigm shift from the consensus that providing ARVs was not feasible in poor settings, to making it a priority. It is also one of two pilot projects in the country to provide treatment for drug-resistant tuberculosis (DR-TB) in clinics while patients live at home, rather than requiring hospitalisation away from family and friends for at least six months.home hiv test, hiv self test, home hiv kit

Doctors working in Khayelitsha hailed the first of December 2009 as the first “happy” World AIDS Day this country had ever seen. Indeed President Zuma’s speech and the newly approved HIV treatment guidelines include evidence-based HIV and TB policy shifts that many had been fighting for for years, such as providing ARVs to all HIV-infected infants and to pregnant women and people with TB with a CD4 count of less than 350. The President also committed to treating TB and HIV “under one roof” and ensuring that all the health institutions in the country are ready to assist patients and not just a few accredited ARV centres.home hiv test, hiv self test, home hiv kit