Elisa: free and anonymous hiv testing

Lessons learned

Elisa centre of Médecins sans Frontières

• Start 1989

• Objectives: -reach at risk groups

-making testing easy

-primary prevention

• Since 1992: + 2000 tests/year

• 2006: public funding and handover

Primary prevention

• pre- and post counselling

• continuity

• few numbers (0.29% of all tests)

• At risk groups

Making testing easy

• Specialised centre (15 %)

• Accessibility (30 %)

• Free of charge (50 %)

• Anonymous testing (60 %)

Free of charge

• 50 % of all consultants

• IDU: 64.8 %

• Heterosexual women: 63.4 %

• Younger than 20: 71.1 %

Anonymous testing

• 60 % of all consultants

• MSM: 70 %

• Younger than 20: 65 %

Anonymity

• Freedom of speech

• Don’t trust confidentiality

• Fear of discrimination

• Extra-marital relation

• If positive, to choose when and whom ( to tell, treatment)

Reach at risk groups:

Infections rate: 11.1/1000 tests

7 times rate in confidential testing

N ew H IV d iag n o ses / 1000 tes ts a t B ru sse ls A F T C en tre vs co n fid en tia l tes tin g s ites ,

B e lg iu m , 1990 - 2002

I P H - 2003

0

4

8

12

16

20

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

A nonymousC onfidential

N ew H IV d iagnoses / 1000 tes ts

R R : 7.49; p<0.001

Risk factors

• Age : > 30 years

• Nationality: sub–saharan or european non-belgian

• MSM

• IDU

I P H - 2003

N ew H IV d iagnoses / 1000 tes tsN umber o f tes ts

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

B elg ia n W es t.E urop .

C entr ./E as t.E u rop .

N orthA fric a

S ub saharanA fr ic a

other0

10

20

30

40

50

60

70

80

90

N b tes ts

N ew H I V /1000 tes ts

N ew H IV d iag n o ses p er n a tio n a lity , B ru sse ls A F T C en tre , 1988 - 2002

N ationality

Risk groups

• Sub-Saharan nationalities: 8.1 %

(women: 12.1 % ; men: 5,6 %)

• MSM: 2.2 %

• Sub-S and MSM: 90 % of all cases

I P H - 2003

N ew H IV d iag nos es / 1000 tes ts

S ex and nationa lity

0

20

40

60

80

1 00

1 20

1 40

M F M F M F M F M F

B elg ia n W es t. E uro p . C en tr./E a st.E urop .

N orth A fric a S ub s ah aran Af ric a

N e w H IV d ia g n o s e s p e r s e x a n d n a tio n a lity , B ru s s e ls A F T C e n tre , 1 9 8 8 - 2 0 0 2

Conclusions

• Importance of free and anonymous testing

• Acknowledge risk groups

• Risk groups: how to reach them, how to teach them ?