Bain Luchuo Engelbert, Ditah Chobufo Muchi, Awah Paschal Kum, Ekukwe Nkoke Clovis
Department of Military Health, Ministry of Defense, Yaoundé, Cameroon; Center for Population Studies and Health Promotion, CPSHP, Yaoundé, Cameroon.
Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Israel.
Pan Afr Med J. 2016 Oct 26;25:114. doi: 10.11604/pamj.2016.25.114.8303. eCollection 2016.
The use of combined Anti-Retroviral Therapy (cART) has been revolutionary in the history of the fight against HIV-AIDS, with remarkable reductions in HIV associated morbidity and mortality. Knowing one's HIV status early, not only increases chances of early initiation of effective, affordable and available treatment, but has lately been associated with an important potential to reduce disease transmission. A public health priority lately has been to lay emphasis on early and wide spread HIV screening. With many countries having already in the market over the counter self-testing kits, the ethical question whether self-testing in HIV with such kits is acceptable remains unanswered. Many Western authors have been firm on the fact that this approach enhances patient autonomy and is ethically grounded. We argue that the notion of patient autonomy as proposed by most ethicists assumes perfect understanding of information around HIV, neglects HIV associated stigma as well as proper identification of risky situations that warrant an HIV test. Putting traditional clinic based HIV screening practice into the shadows might be too early, especially for developing countries and potentially very dangerous. Encouraging self-testing as a measure to accompany clinic based testing in our opinion stands as main precondition for public health to invest in HIV self-testing. We agree with most authors that hard to reach risky groups like men and Men Who Have Sex with Men (MSM) are easily reached with the self-testing approach. However, linking self-testers to the medical services they need remains a key challenge, and an understudied indispensable obstacle in making this approach to obtain its desired goals.
联合抗逆转录病毒疗法（cART）的使用在抗击艾滋病毒/艾滋病的历史上具有革命性意义，与艾滋病毒相关的发病率和死亡率显著降低。尽早了解自己的艾滋病毒感染状况，不仅增加了尽早开始有效、可负担且可获得治疗的机会，而且最近还被认为具有减少疾病传播的重要潜力。最近，公共卫生的一个优先事项是强调早期广泛的艾滋病毒筛查。由于许多国家已经在市场上推出了非处方自我检测试剂盒，使用此类试剂盒进行艾滋病毒自我检测是否可接受这一伦理问题仍未得到解答。许多西方作者坚信这种方法增强了患者自主权且有伦理依据。我们认为，大多数伦理学家提出的患者自主权概念假定对艾滋病毒相关信息有完美的理解，忽视了与艾滋病毒相关的耻辱感以及对需要进行艾滋病毒检测的危险情况的正确识别。将传统的基于诊所的艾滋病毒筛查做法置于次要地位可能为时过早，尤其是对发展中国家而言，而且可能非常危险。在我们看来，鼓励自我检测作为基于诊所检测的一种补充措施，是公共卫生部门投资于艾滋病毒自我检测的主要前提条件。我们同意大多数作者的观点，即自我检测方法能够轻易覆盖到难以接触到的高危人群，如男性和男男性行为者（MSM）。然而，将自我检测者与他们所需的医疗服务联系起来仍然是一个关键挑战，也是实现这一方法预期目标过程中一个尚未充分研究但不可或缺的障碍。
