July 27, 2015

Self-testing helps combat HIV in adolescents

This post originally appeared on WHO’s website here.

Today only half of people living with HIV are aware of their status. This “testing gap”, coupled with the importance of early treatment for HIV, is driving interest in of the role of self-testing for HIV.

“If I went to a clinic and the tester was someone I knew, I would just greet her, ask about her family and then go away without being tested for HIV. Most people have to go to clinics far away where they are not known by anyone in order to be tested.”

Concerns about confidentiality and privacy are one of the key barriers to HIV testing services for adolescents (aged 10-19), as expressed by this young woman in Malawi. However, recent studies on the use of HIV self-tests suggest that the availability of a simple and discreet way to know their status themselves may be one of the keys to dramatically increasing the number of adolescents who take a test and go on to access support and further HIV testing, prevention, treatment and care.

Heavy burden of HIV infection in adolescents

As a group, adolescents and young people are often extremely vulnerable to HIV infection, both socially and economically. AIDS is now the leading cause of death among adolescents in Africa and the second cause of death among adolescents worldwide.

Globally, in 2014 there were 220 000 new HIV infections among adolescents, with more than 60% among young girls and women – a figure which is even higher in sub-Saharan Africa. Yet, despite these facts, adolescents are less likely to be tested for HIV than adults.

A role for HIV self-testing

Evidence is growing on the role HIV self-testing could play in helping countries reach the 90-90-90 UN targets, which call for a scale-up of HIV testing so that 90% of people with HIV are aware of their infection. In its newly-released Consolidated guidelines on HIV testing services, the World Health Organization encourages countries to conduct pilot programmes on HIV self-testing so it can gather and synthesize evidence on the role self-tests can play in closing the HIV testing gap. The Organization plans to release normative guidelines for HIV self-testing in 2016.

High uptake of HIV self-testing among adolescents

In the first large-scale HIV self-testing demonstration project in Africa, all adults (over 16 years) in the community of Blantyre in Malawi were offered a single HIV self-test. While uptake of the tests in the community was high in general, it was adolescents and young adults whose uptake was highest. Within 12 months of the introduction of HIV self-testing in the community, almost all adolescent (16-19 year old) girls were self-testing, as were over 80% of adolescent males.

Such figures are unprecedented in a group that is often reluctant to or unable to be tested for HIV—frequently due to social, structural and health system barriers. “In our community, the youths are the ones who are now coming here in large numbers to take self-test kits. They say they want to prepare for their future,” said one community counsellor working in Blantyre.

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