Although rates of new HIV infections have been going down since the 1990s, in many places in the world, including Africa these declines have leveled off over the past 5 years and getting people to be aware of their status remains a challenge. Innovative solutions are needed to close this testing gap – which is the impetus behind the UNITAID/PSI HIV Self-Testing Africa (STAR) Project, a four-year initiative to catalyse the market for HIV self-testing. the testing technology introduced by STAR makes it possible for people to administer a rapid oral self-test, by themselves or with someone they can trust, without professional help or visiting the clinic. However its success depends on how well information about it is communicated to the target groups, and its ability to avoid unintended social harms that come from knowledge of HIV in the community.
I spoke to Dr Melissa Neuman from the London School of Hygiene and Tropical Medicine (LSHTM), one of the epidemiologists supporting the project. Although the project is acollaboration between academic institutions, healthcare organisations, the World Health Organization, and national governments in Malawi, Zambia and Zimbabwe, Dr Neuman says that their shared desire for increased HIV self-testing on the continent makes the aim of the project achievable.
Dr Neuman explains that one of the key objectives of STAR is reaching people at risk for HIV who may not otherwise test. For example, young men are one vulnerable group who can benefit from HIV self-testing, because often the fact that pregnant mothers are tested for HIV during their pregnancy can lead to healthcare being considered a “female space” in the community, as the hospitals are largely comprised of women and children. Dr Neuman says that the project will begin to work in collaboration with different organisations who work locally with other vulnerable groups, including sex workers, disabled people, domestic workers, people who use or inject drugs and MSM (men who have sex with men).
The importance of monitoring unintended social harms which may result from increased knowledge of HIV in the community is paramount. These include forced testing, difficulty accepting a positive test and an increase in intimate partner violence (IPV). Dr Neuman says that although STAR is still in its first phase and hasn’t collected much data in these areas, unfortunately social harms such as IPV are often the result of “larger structural issues”, and therefore difficult to always consider in relation to a particular healthcare initiative. Nonetheless, understanding the correlation with social harms and acting to mitigate potential unintended consequences is crucial.
Development and healthcare are often seen as intimately linked, as improved health drives the development of the economy. However, in response to questions about development in connection with the STAR project, Dr Neuman states that this project is fundamentally concerned with implementing innovative technological innovations, and is therefore “more directly concerned with healthcare than development”
To find out more about the STAR project, visit: http://hivstar.lshtm.ac.uk/news