HEALTH: Rapid HIV Testing Hailed as Boon for Pregnant Women

by Katherine Stapp

NEW YORK, Nov 28 (IPS) - Women's advocates are hailing a new HIV test that gives results in minutes, although they say that counselling and prevention are still key in fighting the disease.

The test, called OraQuick, will be available for sale to the nearly 40,000 qualified locations in the United States certified to perform moderately complex diagnostic tests.

''The rapid tests will be very helpful for pregnant women who show up in labour and do not know their status - a not uncommon occurrence among marginalized women,'' said Lori Heise, of the Seattle-based Programme for Appropriate Technology in Health.

''Now, providers will be able to tell quickly whether to initiate anti-HIV drugs to help prevent transmission of the virus to the woman's baby,'' Heise said.

Traditional HIV tests take about a week to be processed at a laboratory, compared to 20 minutes for the new rapid test. Since about 8,000 HIV-infected people in the United States never return to get their test results, a rapid test is considered a major breakthrough in efforts to contain the disease and get immediate treatment for those who need it.

But people who believe they may be newly infected will have to wait for their results. Heise noted that ''women who are raped will still have to go through an agonising period of waiting, because the new test still depends on detecting antibodies to the virus, which do not develop immediately - it can take up to six months''.

Other advocates point out that rapid testing could at least ease the emotional burden for rape victims, even though they still have to wait for definitive results.

''Because of the trauma associated with rape, and the way getting tested for and getting the results of an HIV test might make women re-live that trauma, possibly some women would not return to get the results of their test because that would be re-experiencing this trauma one more time,'' said Eric Friedman, a fellow with Physicians for Human Rights.

''That problem would be eliminated - or at least diminished; conceivably some people might not go in the first place - with rapid HIV tests,'' Friedman noted.

The United Nations said this week that about 19 million people, or one-half of those living with HIV worldwide, are now women.

An estimated 17 million HIV tests are conducted annually in the United States at qualified locations. Now, a coalition of groups is pushing to make the test even more widely available, for example, at women's clinics and battered women's shelters that may not qualify to administer it under the current rules.

''Unless we can provide this test to those individuals who need it most, we will continue to win small battles against HIV disease but not the war against AIDS,'' said A. Gene Copello, executive director of Florida AIDS Action.

Copello's group and dozens of others want the Food and Drug Administration to give OraQuick ''waived'' status under the Clinical Laboratories Improvement Act (CLIA).

''Without a waived status under CLIA, 90 percent of the states have told us they will either not be able to implement rapid tests, or will only be able to offer them on a very limited basis,'' said Laura Hanen, director of government relations for the National Alliance of State and Territorial AIDS Directors.

Many experts stress the importance of compassion and non-coercion in conducting any kind of HIV testing.

Stephanie Urdang, an adviser to the United Nations on Gender and HIV/AIDS, notes that emotional support is critical. ''Absolutely key to this is the provision of really sound, gender-sensitive voluntary testing and counselling,'' she said.

''If the counselling does not take into account the cultural and gender issues, then women can be placed in a really compromised and difficult situation.''

''If she suspects that health workers would pressure her to be tested and she would get the results immediately, this might deter her from going for needed medical treatment in the first place,'' Urdang cautioned.

And while HIV/AIDS advocates are excited about the advent of rapid testing, they note that it will not do anything to halt new infections.

''Testing is not HIV prevention, as some suggest - any more than mammography is breast cancer prevention,'' noted Leslie Wolfe of the Centre for Women Policy Studies in Washington. ''But early diagnosis is essential for women, and I would hope we will now see attention paid to development of woman-friendly HIV prevention programmes and messages.''

Foremost among these would be the creation of an effective microbicide, a topical cream that has the ability to prevent the sexual transmission of HIV and other diseases. A microbicide could take many forms, including gels, creams, suppositories, films, or as a sponge or ring that releases the active ingredient over time.

Although researchers have been making progress in this area, experts say microbicides are probably about five to seven years away. ''In the U.S. and around the world, women remain at high risk for HIV because they often cannot negotiate condom use without risk of violence, suspicion or worse,'' said David Ernesto Munar of the AIDS Foundation of Chicago.

''Development of such (microbicide) products would have a dramatic effect toward lowering HIV rates worldwide, and would especially benefit women by providing them with a barrier to HIV infection that they could control,'' he added.

Wolfe agreed wholeheartedly. ''Obviously, what we need most is the woman-controlled HIV prevention method,'' she said. (END/2002)