A reader has commented on the posting "Testing is not prevention".
Reader: "I agree with you that testing alone can't prevent HIV transmission. But, VCCT is not only about testing, but also include risk assessment and risk reduction counseling. It surely does affect on behaviour change of the person. VCCT should benefit both test positive and test negative if it is done effectively by the skillful counselor. The point is that counselors can't give enough time to do effective counseling and moreover they hardly do negative post test counseling which is very important in prevention of HIV transmission.
I also agree with you that testing should also be in treatment programme. But, now-a-day the line between the treatment and prevention is very very thin. We are doing treatment as prevention so all activities under treatment programme should also belong to prevention programme.
Testing is the entry point for any HIV programme so that we should encourage people to do HIV testing especially for high risks but also for low risks. And we should encourage donors to improve funding on testing programme because without HIV testing, we can't prevent HIV transmission."
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The [him] moderator replies:
As public health professionals or community members we need to look for scientifice evidence that what we do is effective to prevent HIV acquisition and transmission. Condoms, sterile injecting equipment, and oral substitution treatment for opiate injectors have scientific evidence to support their effectiveness. I respect your opinion that counselling and testing has an impact on subsequent behaviour for those who test negative but there is NO scientific evidence for your opinion. The scientific evidence reviewed by the Cochrane collaborators shows that seropositives may change their behaviour but seronegatives do not. And there has been little study of people who inject drugs and their post counselling and testing behaviour.
There is as yet NO scientific evidence that treatment has any impact on transmission at a community level. In the community, prevention is prevention and treatment is treatment. All else is simply theory.
Scientific evidence shows that testing of people at low risk increases the number of false positives. HIV transmission was being prevented in the early 1980s before tests were even invented. So HIV testing is neither necessary nor sufficient to prevent transmission.
If funders fund testing, they should fund it as the gateway to care for individuals at higher risk.
Jamie
