The fight against AIDS

Here's a little extract from today's "New Times" newspaper which gives you a perfect examnple of the day to day problems we face here in trying to reduce the incidence of HIV. You're fighting against traditional beliefs and especially men's insecurity - they're desperately afraid that they'll be shown as "weak" if they test positive, so they prefer not to be tested. Ignorance is bliss.......

It's a particularly typical Rwandan slant on the situation that in the last paragraph you notice that the Police chief and director of medical services appears to be the same person. So no potential conflicts of interest over confidentiality here, then......

KAYONZA — Men in the Kayonza district are shunning voluntary HIV testing, which is proving to be an impediment to the fight against the HIV/AIDs scourge.
Technical assistant, for the District Aids Control Commission (DACC), Edouard Muhima Luhayisha, further revealed that despite the fact that Saturdays had been set aside for the testing of couples at specified centres, only women turned up for testing.

These women are sent back for their reluctant husbands, and often they themselves don’t return, but instead choose to go to other health centres where they don’t have to be accompanied by their husbands.

Apart from shunning the tests, health officials say men normally blame their spouses whenever they test positive. This year’s theme for the fight against HIV/Aids focuses on testing of couples.

According to Muhima, men claim they know their HIV status from the results of their partner’s test, which is wrong because there are cases of discordant couples where only one partner is infected.

“It is funny sometimes they assume that a woman’s results would automatically be similar to theirs. And when a woman tests negative, her husband blames her for infecting him,” Muhima explains.

According to the November-December 2008 HIV test results in the district, of the 22,962 couples tested, 262 couples tested positive, while 424 were found to be discordant couples.

Muhima says they have embarked on a sensitisation campaign to bring men on board, warning that women could lose heart in the exercise if their husbands remain reluctant. He is however optimistic that the campaign is bearing fruit as more people have started going for testing and counselling.

“The campaign also involves encouraging married partners to remain faithful to each other,” he concludes.

Meanwhile, the Assistant Commissioner of Police and Director of Medical Services, Dr. Wilson Rubanzaha calls on couples to report cases of infidelity. Addressing residents on health issues recently, he advised married couples to be faithful to their partners and urged infected couples to use condoms to avoid re-infection.

What I find interesting is that the infection rate is so low - 486 positive results in 22962 couples is only 2.1% which is remarkably low for sub-sharan Africa. So is it the case that the only people who turn up for testing are those who are pretty sure they'll test negative?