Work

Nothing about us without us: considerations for ensuring rights‐affirming index case testing for young people

Year: 2020

Type: article

Abstract: Index case testing (ICT)—HIV testing among exposed sexual, injection and biological (i.e. children) contacts of people living with HIV, often those who are newly diagnosed or virally unsuppressed—is an effective approach to optimize HIV testing by increasing positivity yields (or the proportion of people testing HIV-positive among those tested). ICT may also optimize linkage to and uptake of HIV prevention services, including pre-exposure prophylaxis and voluntary medical male circumcision, among contacts who do not regularly access health services and who test HIV-negative. In 2019, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) prioritized optimization of HIV testing, including scaling up ICT and partner notification services (PNS), to enhance HIV case identification. PNS, under the umbrella of ICT, can be assisted or made through passive referrals. Assisted PNS can include provider support to patients to disclose their HIV status to partners or provider-initiated anonymous disclosure to partners and HIV testing [1]. In contrast, passive PNS includes patients disclosing their HIV status to their partners on their own and encouraging them to seek HIV testing [1]. Across HIV testing modalities, ICT, including PNS, produced the highest yield and identified the second largest number of HIV cases across PEPFAR-supported programmes in 2019 [2]. The scale-up of ICT, while effective, has been met with concern from advocates, who have outlined potential human rights concerns, including rights to informed consent, exposure to violence and criminalization of HIV exposure and/or transmission [1, 3, 4]. Equally, advocates have raised concerns about PEPFAR establishing country-specific targets for ICT and their resulting impacts on service quality [3]. Concerns and guidance on appropriate delivery of ICT have been broad and silent on special considerations for youth populations. This Viewpoint reflects concerted, collaborative efforts among young scholars and advocates globally to address this gap in guidance and articulate considerations to guide implementation of ICT for youth. While ICT and PNS are vital strategies to strengthen HIV case identification, these approaches must be thoroughly interrogated considering suboptimal implementation fidelity. The AIDS 2020 Youth Force advises PEPFAR and national HIV programmes to consult and meaningfully engage youth living with and affected by HIV as minimum standards and monitoring mechanisms for ICT are developed to ensure acceptability, safe delivery and uptake among youth. The authors declare no competing interests. LP and JGR drafted viewpoint. ON, MV, AS, AIN and AT reviewed viewpoint. All authors approved the contents of this Viewpoint. The AIDS 2020 Youth Force aims to ensure inclusive and meaningful youth engagement in the AIDS 2020 conference. All authors are Co-Chairs of the AIDS 2020 Youth Force Working Groups or members of the AIDS 2020 Youth Force. LP serves as the Co-Chair of the Advocacy Working Group for the AIDS 2020 Youth Force. ON, MV and AS serve as IAS Youth Ambassadors. AIN serves as the Co-Chair of the Youth Pre-Conference Working Group for the AIDS 2020 Youth Force. AT serves as the Co-Chair of the Global Village Programming Working Group for the AIDS 2020 Youth Force. ICT, Index case testing; IPV, Intimate partner violence; KP, Key populations; PEPFAR, U.S. President’s Emergency Plan for AIDS Relief; PNS, Partner notification services. The authors thank all members of the AIDS 2020 Youth Force for their participation in Youth Force activities and input on this Viewpoint. The contents in this Viewpoint represent the views of the authors and members of the AIDS 2020 Youth Force and do not necessarily reflect the views of the authors’ affiliations.

Source: Journal of the International AIDS Society

DOI: 10.1002/jia2.25595