Promoting self-testing for HIV in developing countries: potential benefits and pitfalls.

The prevalence of the human immunod deficiency virus (HIV) in developing countries is a growing problem. By 2003, an estimated 38 million people worldwide were infected with HIV, with approximately 14 000 new infections occurring each day.1 Some 2.3 million children worldwide are infected with HIV and they account for 18% of all deaths related to the acquired immunod deficiency syndrome (AIDS).2 I should like to add to the discussion on prevend tive measures for reducing the prevalence and incidence of HIV by weighing the potential benefits of promoting selfdtestd ing for HIV in developing countries and the concerns that need to be raised. Research reveals two common read sons why people do not attend HIV counselling: limited HIV testing services, and social stigma and discrimination asd sociated with HIV infection.1 Both these factors play a prominent role in the lack of HIV awareness among people in developing countries and may lead to errors in HIV reporting. People living in remote areas remain unscreened if local testing services are not available, because they cannot afford the time involved to go to fardoff facilities and the consequent loss of pay. Other concerns such as lack of privacy, overworked clinics and phyd sicians’ reluctance to test are cofactors in low screening rates. Selfdtesting will help overcome these objections and is a convenient option compared with the conventional methods of testing. People’s ignorance of their HIV status creates serious problems. Research shows that approximately 25% of HIVd positive people in the United States are transmitting the virus to others, as they are unaware of their status.1 This propord tion is likely to be higher in developing countries, in view of lower literacy rates. Marks et al. report from their study in