Monday, November 02, 2009
What happens when you ask a group of people to imagine that they are charged with the task of promoting a community-wide plan to get everyone tested for HIV? This is an experiment that we have been doing over the past few months, and it has been enlightening for me, as well as educational for the participants as questions about open up for conversations about the current system. Inevitably, issues of mandated vs. voluntary testing come up, and it is readily agreed that voluntary testing is the best way to go. But we can effectively promote a culture that makes HIV-testing the norm rather than the exception through marketing, and making access to testing as easy as possible. Issues about reporting and linkage to care also come up, but these are already issues in the current system, and issues that the current system has not been able to overcome.
Given that over-the-counter (OTC) rapid HIV-tests could become a reality in the near future, I have asked groups to consider ideas for promoting "KNOW YOUR STATUS". Here is a list of what two classes at Wilmington (OH) College came up with recently:
- Do HIV-testing in 7th grade
- Institute guidelines that offer HIV-testing upon high school graduation or earning a GED
- Routine testing at medical appointments
- Encourage HIV-testing when getting drivers licenses/state ID's, or registering a motor vehicle
- Include information about HIV-testing on cigarette and alcohol packaging
- Include HIV-testing as part of a marriage license
- For employers, ask/encourage new hires to get tested, but not tying in results of the test to employment. A precedent for this is at a tea company in Kenya that offered testing and counseling, and insured that the employer did not know the employee's status. The result was a decrease in absenteeism.
- Offer a tax-deduction for those who got tested (or purchased a test, at least)
Each one of these, in and of themselves, can raise concerns when they move towards "mandated" vs. voluntary, and it is a healthy discussion. The point is that there are many things we can do.
Compare this with what "experts" tend to come up with: expanding HIV-testing to ER/hospital admissions, and paying people with HIV to get into care. The blind spot here is that they are looking at ways to get people to where they are (looking from the inside out), whereas The Mosaic Initiative and William Penn House, through this work, are encouraging and nurturing an approach that remains outside the system. The hopefully-impending approval of OTC rapid tests can move this effort far further far faster than we could have imagined even 6 months ago.
How do you think you can use OTC rapid tests to complement the current system to move us towards the goal of getting all people to know their status?