It’s Saturday night on one of the main streets of Kisumu town. Against the backdrop of a busy night scene—music blaring from a nearby shop, people of all ages milling about in the street—are six Coleman camping tents which have been set up on the side of the road. Three bare lightbulbs strung across the row cast a pale light over the tents, which tonight are serving as private consultation rooms for voluntary testing and counseling of HIV. People congregate outside the tents, waiting their turn for the free service, asking questions and raising concerns about HIV and its mode of transmission, treatment options, and what it will means to know their status. Inside the tents, which are all occupied, HIV counselors provide information on these very issues for people who would otherwise not make it to a health center.
Several days later, many miles north of Kisumu in Wenyila village of Bungoma East District, Florence and Matutu, two skilled counselors, go door-to-door in an HIV counseling and testing program designed to leave no one behind. This is their second week canvassing the village to reach all 140 households, which were alerted prior to their visit by a respected member of the community. Florence and Matutu carry their green Home Counseling and Testing bags over their shoulders, stocked full with HIV testing accessories, and the electronic handheld device on which they gather detailed information about the household and the individual’s HIV status. If someone in the household is HIV positive, the counselors will set up an appointment for them at the nearest health center, will even offer to accompany them to the facility, and will return to do a follow-up if the person does not make their appointment. High priority is given to pregnant women that are HIV-positive to ensure they will be able to access treatment to prevent the transmission of the virus to their child.
Innovative approaches such as the Twilight Voluntary Counseling and Testing and the Health at Home Initiative are important for making HIV testing and counseling accessible to more people. HIV testing and counseling is often referred to as the gateway to prevention, treatment, and care, because it is essential for people to know their status in order to stop the spread of the virus and to be referred to treatment without delay. While the number of health facilities providing HIV counseling and testing in sub-Saharan Africa has grown rapidly in recent years as governments work toward universal access to HIV prevention, treatment and care, a very large part of the population remains unaware of their HIV status.
Community-based approaches have great potential to reach the segment of the population that is not able to invest the time, effort, and resources to get to a health facility for testing. During the night I visited the Twilight VCT, supported by Ringroad Clinic in the Nyalenda slum and Marie Stopes Kenya, I talked to men and female sex workers who thought it very convenient that these services were being offered at a time (6 to 10 pm) and in a place where they could be easily reached. Men in general and commercial sex workers are two groups that often do not come for testing in a facility setting. Florence and Matatu, the counselors with AMPATH (Academic Model for the Prevention and Treatment of HIV) were essentially reaching all community members, many of which did not have access to testing prior to the visit. More than half of the people I met that day in their homes had never had an HIV test and knew very little about the virus.
The 2009 United Nations report on universal access to HIV prevention, treatment, and care discusses where the global health community stands on this internationally endorsed goal. Although many indicators are moving in the right direction, many countries are still far from reaching the goal of universal access. While the number of people in 2008 who received HIV testing and counseling increased over the previous year, recent surveys indicate that more than half of all people living with HIV are unaware of their status.
Direct Relief is helping to address this issue by providing donations of Determine rapid HIV tests in partnership with Abbott, so that more people are able to know their status, primarily pregnant women to work to prevent the transmission to their child. The rapid test is an important tool in diagnosing HIV, but universal access to testing and counseling—and to the essential treatment and care which must accompany it—is only going to be accomplished if a variety of strategies are used. Innovative approaches like the Home Counseling and Testing and Twilight VCT are bringing us one small step closer.