HIV Testing, One Home At A Time

Hello TMM readers.

Today on World AIDS Day, the Kenyan government announced it's launching an intensive three-week drive to provide HIV tests in workplaces, at home, during the evening, and in mobile test centers. The government hopes to get one million people tested and into treatment programs if needed. Between 7 and 8.5% of Kenya's adult population is living with HIV/AIDS.

Tell Me More Senior Editor Kitty Eisele recently traveled to Kenya, where she witnessed the reality of offering HIV tests - one home at a time - in action.

Kitty, I'll let you take it from here ...

Thanks Douglas.

It says a great deal about where we've come in the fight against AIDS that a health counselor in Kenya, equipped only with a backpack, can travel on foot to a mud-walled farmstead and administer a 15-minute home HIV test to a rural farmer, his three wives and their multiple children. And that this is considered so normal, the family would consent to the presence of a Western journalist at what would seem the most delicate, fraught moment in their lifetimes.

I accompanied health worker Florence Aluodel to this test last summer, traveling as a Fellow with the International Reporting Project at Johns Hopkins School of Advanced International Studies.

Though I soon learned she had made an earlier trip to this family, and that all but one member had tested negative.

Today's visit was a follow-up, to see how 44-year-old Catherine, the third and youngest wife, and a woman both deaf and mute, was coping with her diagnosis. Florence explained to me that Catherine understood her condition, and was greatly relieved that her own daughter had not contracted the virus. That said, to be witness to a family's most intimate discussions made me uneasy. Except that Kenya is doing what many African nations have had to do: normalize the experience of living with HIV.

Health Counselor Florence Aluodo (far left) administered home HIV tests to this family in Kogelo, Ke

Health Counselor Florence Aluodo (far left) administered home HIV tests to this family in Kogelo, Kenya. Dante Ramos/International Reporting Project hide caption

itoggle caption Dante Ramos/International Reporting Project

Sub-Saharan Africa accounts for two-thirds of the 33 million people living with HIV-AIDS. In Kenya, the Ministry of Health is working with the Centers for Disease Control in remote villages like this one, to provide in-home AIDS testing and counseling, as a way to ensure that as many people as possible receive a diagnosis, so they can be enrolled in treatment programs as soon as they are tested.

Florence explained to me how it works: local elders are approached as conduits, to inform villagers that the government is offering home testing, in a confidential and private setting, and to urge neighbors to accept these tests as a way to best support community health, whatever the outcome. The elders work as the go-betweens, softening the terrain, for outsiders to visit.

Then a trained health care worker from a different region, who will not know any of her clients, is brought in to administer the tests and provide pre- and post-test counseling. The thinking is that this disease plays out among families, and that spouses and couples are best served when they can be addressed together, as a family unit, in the privacy of their own homes, and given tools and discussion guidance in order to manage what news may come. Having the test administered by an outsider, it is thought, preserves a family's confidentiality and dignity within the community.

Florence was that outsider, equipped with a backpack full of plastic gloves, needles to draw blood, and safe disposal units for the "sharps." As a trained counselor, it was she who would speak confidentially to each family, guiding their understanding and checking in with them over the course of a month to answer questions, provide information, and most crucially, enroll them in medical support systems to begin drug treatments.

Florence explained, and the CDC confirmed, that in the villages where this service is offered, the compliance rate is 80%. Imagine that in the US: 80% of your neighbors accepting the visit of a complete stranger, to test them for a virus that eventually will kill them.

In Kenya, several regions serve as Demographic Surveillance Areas for the CDC: villages that permit health agencies to monitor disease trajectories, and in return, to receive full medical treatment. (I saw some of these activities as well in Africa's largest slum, Kibera, where tuberculosis and other infectious diseases are being monitored weekly by local community members armed with pills, empathy, and a Palm Pilot, to enter detailed accounts of symptoms, compliance and overall health.)

Although Catherine could not say how she came to be infected when her husband and co-wives were not, a polite story was observed, involving razors and other sharp instruments that may have been shared. Or not. Perhaps she'd contracted the disease well before her marriage. The route of infection seemed less important to the family than the news that one of their own would need care. And I was truly moved by the pronouncement of her 78-year old husband, and another of his wives, that Catherine would be well-cared for, that, as a member of the family, she would find her support among those she loved.

It's hardly a drop in the bucket. But it is a positive scene amidst so many of such desperation.

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