Premarital HIV Counseling and testing for couples: A neglected opportunity Claudes Kamenga Deputy Di

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Premarital HIV Counseling and testing for
couples A neglected opportunity Claudes
Kamenga Deputy Director, Director Technical
SupportAWARE-HIV/AIDS ProjectFamily Health
InternationalJanuary 23, 2008
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Learning Objectives

• Highlight potential contribution of premarital CT
  to prevention and care
• Share experiences on premarital CT
• Initiate discussion on the way forward

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Background

• ART becoming more available
• But only about 10 know their HIV status
• Efforts toward universal access to CT
• Premarital HIV CT one of the options
• But has been neglected

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Premarital CT Wrong focus

• Debate has focused on mandatory aspect
• Therefore wrong arguments against
• Not cost-effective
• Would bar HIV from marriage
• Potential for fraudulent certificates
• Therefore not included in our programs
• Left to families, churches, and municipalities

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Arguments in support of Premarital CT

• Premarital CT offers potential benefits
• Couples have opportunity to negotiate HIV risk
• Contribution to reduction of MTCT
• Access to care and treatment for HIV
• Incentive for safe sexual behavior among youth

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• WHAT IS HAPPENING ON THE
• GROUND?

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Policy level

• National HIV Policies in most countries encourage
  Premarital CT but clearly state that it should
  not be mandatory (i.e. Senegal, Burkina Faso,
  Ghana, Ethiopia, Rwanda, etc.)
• We have not come across a country where
  premarital CT is mandatory
• FBOs (i.e. churches, mosques, etc.) require
  premarital HIV testing (not sure if written
  policies exist)

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Service Level

• No concerted effort at national level to promote
  premarital CT
• However existing CT services see sizeable numbers
  of people requesting HIV testing in preparation
  for marriage (self initiated, families, churches,
  municipalities, etc.)
• Suggesting that there is a demand for premarital
  CT that can be further increased!

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Proportion of premarital CT at 4 FHI supported
Gvt CT sites in Ethiopia

• 304,057 counseled and tested between 2004 and
  2006
• 48,343 (15.9) came for premarital CT
• 5.5 discordant among those coming for premarital
  CT

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Steady increase of CT for marriage at AIC
percent
Turagyenda j et al. Int Conf AIDS. 199812874-5
(abstract no 43138)
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Challenges

• Sex start before decision to marry
• Pressure to get married may make people forego
  the test (especially women)
• Potential for negative social consequences
  especially when done at last minute
• Dealing with discordant couples
• Seroconversion after marriage
• Potential for fraudulent certificates if not
  voluntary
• Etc.

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Thoughts on Way Forward

• Need to ask the right question How best to
  promote Premarital CT without violating human
  rights?
• Right to know
• Duty to know!
• National guidelines and strategies on Premarital
  CT
• Support coordinated implementation efforts
• Beyond Premarital CT pre-engagement testing,
  pre-sex testing, testing at any other life
  milestones (i.e. new job, high school,
  university, etc.)?
• Etc.
• Results not to be shared with third party but
  proof that CT service was used and that
• person learned their HIV status.

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Acknowledgements

• Ms Aida Girma (FHI, Ethiopia)
• Theonille Mukabarasi (FHI, Rwanda)
• Dr. Kwasi Torpey (FHI, Zambia)
• Dr. Prisca Kasonde (FHI, Zambia)
• Ms. Kristina Grabbe (CDC, Atlanta)
• Mr. Jean Marie Tapsoba (CICDoc, Burkina Faso)
• Mr. Karim Diop (SMIT-CRF, Senegal)