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Boosting HIV/AIDS fight through partner, Family Index Testing

Boosting HIV/AIDS fight through partner, Family Index Testing

Due weight is given to Partner Index Testing in response to the need to increase the percentage of people living with HIV (in 2016) with suppressed viral loads from 44 percent to the required 73 percent to achieve the 90-90-90 targets.

“Partner Index Testing” refers to the testing of sexual and needle-sharing partners, while “Family Index Testing” is the testing of the biological children of HIV index clients. Each listed partner and child is contacted, informed that they have been exposed to HIV and offered testing services.

Mrs. Robert (not her real name) and her husband were tested at a Provider-Initiated Counseling and Testing (PICT) center. She was found to have HIV, while her husband was HIV-negative, and they were thus a discordant couple. Her husband is a pastor and they both believed that she contracted HIV through “evil spirits”, saying she had never been unfaithful to her husband.

“My husband has no HIV, so where would HIV come from if not from evil spirits? Mrs. Robert asks.

Her condition worsened in early May 2019, and they went back to the hospital where they were counseled. They were still in denial. The healthcare provider referred them to the CTC for further counseling.  There they met Lina, a counselor.

The couple maintained that the infection was caused by evil spirits, and that there was no need for ARVs. Lina concluded that there was misconception with regard to the mode of transmission of HIV and it was possible that Mrs. Robert knew who infected her, but was afraid to tell her husband. The pastor believed that his wife had never cheated on him and thought that she could be healed through prayers.

Lina decided to have three smaller sessions within the counseling sessions – a joint session for the couple focusing on their religious beliefs vis-à-vis the reality; an individual session with the woman focusing on disclosure and a joint session focusing on decision-making and enrollment in care and treatment.

The joint session: This was the initial session during which Lina explained the various modes of HIV transmission in a way that was neither offending nor discriminating. This was meant to reduce the stigma the couple had with regard to sexual relations and HIV and help them absorb the facts. Lina also sought to prevent finger-pointing following the discordant HIV test results, quoting Matthew 5:22, “…but I say to you that everyone who is angry with his brother will be liable to judgement.” She ended the session when she thought that they both had understood the mode of transmission and asked to hold a short session with the woman.

Individual session with Mrs. Robert: Lina sought to persuade her to disclose her partners. It was not an easy task, and Lina again had to use Bible lines. She had to be truthful and open to her husband and other members of the church led by her husband. Lina wanted Mrs. Robert to be courageous enough by quoting Philippians 4: 12, “I can do all things through him who strengthens me.” Mrs. Robert finally revealed that she had extramarital affairs with two men in Geita where she was asked by her husband to go and supervise work on their farm. The two men work at a gold mine, but she was no longer in touch with them.

 She also admitted to having an affair with a third man working as a clergyman at their church. The discussion ended when she agreed to apologize to her husband and take ARVs.

Conclusive joint session: The husband joined the session and accepted the apology, promising to assist his wife as a treatment supporter. Lina acknowledged her husband’s positive reaction by quoting Matthew 6: 14 – 15, “For if you forgive others their trespasses your heavenly Father will also forgive you, but if you do not forgive others their trespasses neither will your Father forgive your trespasses.”

Before the session ended, the pastor asked his wife to leave the room so that he could have a short discussion with Lina. He revealed that he had an extramarital affair with the wife of his clergyman, who had an affair with his (the pastor’s wife).

The pastor came with the clergyman’s wife to the CTC the next day for testing without his wife’s or the clergyman’s knowledge. She tested negative. The clergyman was tested at his home and was found to have HIV. The clergyman’s wife became her husband’s treatment supporter.

This proves that index elicitation is effective in identifying index contacts and testing them. The service provider’s competence and good interpersonal relations promote the quality and outcome of elicitation sessions. Index testing also increases HIV testing positivity rate and helps meet donor targets.

 Index testing, which is also known as Partner Notification Service, focuses on testing individuals who have had known exposure to HIV.  Index testing starts with an HIV-positive index client. The client is asked to list all their sexual or injecting partners within the past year. In addition, if the client is female, she is asked to identify all her biologic children under the age of 15 who may have been exposed to HIV during pregnancy, childbirth, or breastfeeding.

Supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centre for Disease Control (CDC), Ariel Glaser Pediatric AIDS Health Initiative (AGPAHI) implements HIV/AIDS care and support services in Shinyanga, Simiyu, Mara and Mwanza regions, where these services are provided in accordance with Tanzania’s policies, standards and national prioritie