Free and anonymous testing in Martinique

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Free and anonymous testing in Martinique

• Danielle Quist, A. Cabié, S. Abel,
• S. de Thoré, J. Guinvana, B. Liautaud
• CHU de Fort-de-France, Dispensaire IST,
  Martinique

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Free and anonymous testing in Martinique

• Introduction
• Free access to centres for anonymous counselling
  and HIV testing (CDAG) has been established in
  France since 1988 in hospitals, STI Clinics and
  jails.
• Their main purpose is to stimulate people to
  test for HIV, without consideration of cost or
  lack of confidentiality.

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Free and anonymous testing in Martinique

• Introduction
• In France, CDAG first targeted MSM (the highest
  risk exposed group)
• In Martinique, as in the two other french
  departments of America, HIV is mainly transmitted
  among heterosexual people different purpose
• Since 2000, Hepatitis B and C testing is also
  available

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Free and anonymous testing in Martinique

• In Martinique, there are three sites for free
  and anonymous testing (CDAG)
• University Hospital
• STI clinic (downtown)
• Prison

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Free and anonymous testing in Martinique

• A first consultation is done before the blood
  test, to evaluate with the patient
• His or her knowledge about HIV infection
• His or her sexual behaviour,
• The usefulness of the test which will be taken

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Free and anonymous testing in Martinique

• Then, the blood test is done (or not)
• HIV serology (Elisa Western-blot)
• P24 antigenemia
• Hepatitis B and C serology

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Free and anonymous testing in Martinique

• The results of the blood test are given and
  explained at the second medical consultation
• The counselling is done again
• In case of seropositivity, the patient is
  referred to a specialized structure
• The whole process is anonymous

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Free and anonymous testing in Martinique
University Hospital and STI Clinic
Number of tests 1999 2000 2001 2002 2003
University hospital 552 546 524 569 1139
STI Clinic 420 462 293 225 324
TOTAL 972 1008 817 794 1463

• Sex ratio University hospital 1,15
• STI Clinic 0,85

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Free and anonymous testing in Martinique
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Free and anonymous testing in Martinique

• Prison
• Sex Ratio 19
• Mean Age 35 ans

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Free and anonymous testing in Martinique
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Free and anonymous testing in Martinique

• In Martinique, free and anonymous testing is not
  clearly useful for the screening of seropositive
  patients.
• This could be explained by
• the low prevalence of HIV in the population
• No classical high risk groups, but the main
  risk factor is heterosexual intercourse with a
  lot of partners

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Free and anonymous testing in Martinique

• Volunteer people attending CDAG receive a good
  counselling which may have a positive long-term
  effect on the epidemics
• CDAG can help people fearing a lack of
  confidentiality in our little island, to dare
  taking an HIV test.

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Free and anonymous testing in Martinique

• In a few cases, free and anonymous testing
  allowed to initiate a post exposure treatment to
  people who had recently a high risk sexual
  contact
• and it may help us to initiate quickly a special
  information to targeted groups (prison for
  exemple).

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Free and anonymous testing in Martinique

• Therefore, it is important to have an overview on
  that strategy in Martinique and determine if it
  could be of interest for other Caribbean
  countries which have also a predominantly
  heterosexual transmission of HIV.