This is how we will end the spread of HIV worldwide

We now have the science we need to totally end the spread of HIV worldwide.

But this is a mixed-up world. A world where people who know they are HIV positive are less of a problem than people who assume they are HIV negative.

It’s a world where some medical professionals are more worried about being put out of work than about preventing illness. Where parts of Africa are leading the way while Europe trails behind.

It’s a world where your prospects vary wildly if you are HIV positive, depending on where you live and who you are.

And while there’s enormous advances and cutting edge science, progress is fragile. Some conservatives are destroying lives to see their views triumph.

Give everyone access to testing

Even the simplest step, getting tested for HIV, can be fraught with problems.

Some people can easily pop into a clinic, take a test, and be on their way in less time that it takes to drink a coffee.

But for others it isn’t that easy.

Under 18s may be banned by law from taking a test without parental permission. You have to ask yourself if all sexually-active teens want to explain to their parents why they want one. And that’s not counting the parents who may simply refuse.

In the US, the most likely group to be positive and not know their status are young people between 13 and 24-years-old.

In much of the western world, migrants are at higher risk of being HIV positive. But some fear being deported if they come forward for testing.

Removing these barriers is essential.

Make testing as easy as possible

For others, testing is simply more of a hassle than it needs to be. In the US, people often receive routine blood testing for a range of conditions, like diabetes. But ordering an HIV test is a separate function, requiring different paperwork. In fact, the paperwork can even be different from that required for other sexual health screening.

In the UK, vast strides have been made in encouraging to test. But GSN recently reported on a number of sexual health clinics that have closed down, making tests harder to come by.

The most popular clinic for gay and bi men in Britain is 56 Dean Street in Soho, London. It now books out all of its appointments for the day within seven minutes of them being released.

It’s an urgent problem. In 2014, the US Center for Disease Control reported nearly 166,000 Americans were HIV positive and didn’t know because they weren’t testing. If all of those people knew their status, countless new HIV infections could potentially be prevented.

Despite that there has been huge progress.

The culture of testing has dramatically improved in many places in the world. A decade ago, many gay and bi men in the UK didn’t test regularly. Now many do at least once a year.

South Africa has gone from virtually zero testing and treatment 10 years ago to nearly 4 million people on treatment now. Given they will need to be on treatment for the rest of their lives, it’s an impressive public health commitment. And it shows countries can scale up their efforts dramatically.

Remove legal barriers to testing

In many countries, only doctors, phlebotomists (blood specialists) or other health professionals can test for HIV.

For example, when the HIV/AIDS Alliance in Ukraine lost their funding, they faced having to stop testing. By law, they had to use a doctor to test and they couldn’t afford to employ the doctors they needed.

So they asked a lawyer for help. They discovered lawmakers made the rule before HIV tests became so simple you can do them on yourself. Because of that, it was illegal for non-doctors to test other people, but not for people to test themselves.

The Alliance used that loophole. They taught their staff to help people test themselves, and give them support if they are positive. In 2015, the Alliance used this to carry out 200,000 tests and diagnose 4,000 people with HIV.

Roll out home testing

HIV can now be detected with a simple finger-prick blood test. In fact, it’s so easy that you don’t even need to be a doctor or nurse. You can use a home testing kit and get a result in minutes.

At least, that’s the theory. In practice there are huge barriers in the way.

Across Europe, home testing is illegal in the majority of countries. You can home test in Britain, France, Romania and Ukraine. But you can’t in Germany, Spain, Serbia or Italy.

Even when home testing is legal, it’s not easily available. No UK high street supermarket or pharmacist stocks HIV testing kits at present. In fact, GSN is working with partners to crack that problem with a trial project coming soon.

And perhaps it shouldn’t surprise us that some doctors oppose home testing – they fear it’s a job killer. We need to educate them to embrace this change.

Obviously, people who home test need appropriate support if the test is positive. But if that’s in place, home testing can take a lot of pressure off health services.

Get positive people on treatment

If you are HIV positive, your ‘viral load’ determines how likely you are to transmit the virus.

HIV treatment doesn’t remove the virus from your body – it’s not a cure. But it can control the virus so it doesn’t harm your health.

One of the other advantages of drugs to treat HIV, is they…

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