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Lancet. 1994 Apr 16;343(8903):960-2.

Personal screening for HIV in developing countries.

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Department of Epidemiology, University of California Los Angeles 90024.



A study of military recruits in Thailand found that HIV is 30-50 times more transmissible for females-to-males than estimated earlier. Many top AIDS researchers are uncertain about HIV. New knowledge about HIV contradict old assumptions. Public health professionals need to remain open to new thoughts and new programs. A new approach to controlling the HIV epidemic may be voluntary and anonymous HIV testing. Accurate, acceptable, and inexpensive HIV screening assays to detect HIV antibodies in saliva exist. Political will can make them available through pharmacies, grocery stores, or medical clinics. It can also advocate the evaluation of extensive self-testing as a strategy to control the HIV epidemic. If people were to use the home testing results to refrain from intercourse with an infected partner, home testing might decrease their risk by 95-99%. People whose sexual partners are tested and who use condoms would be at the lowest risk of HIV transmission. Anyone with a positive saliva test should seek a medical practitioner for confirmatory testing with blood. Home testing would greatly reduce the need for widespread venipuncture screening facilities and labor intensive pretest counseling sessions, both of which contribute considerably to the cost and inconvenience of testing in many developing countries. It would allow health officials to dedicate more of their scarce resources to HIV-infected patients. The HIV epidemic is gaining momentum despite much technical and financial assistance to support HIV control activities. No large-scale HIV testing is done in Thailand, so most people do not know whether they or their sexual partners are HIV seropositive. The recommendation of using condoms for every act of intercourse is unrealistic for married Thai couples (just 5% of such couples always use condoms). Home screening would help prevent individuals from marrying an HIV-infected individual. It would also promote monogamy.

[Indexed for MEDLINE]

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