World AIDS Day 2017: Two Years and a World of Difference

By Petra Stankard, Senior Technical Advisor – HIV & TB, PSI

Two years to this day – on World AIDS Day 2015 – PSI, Unitaid and partners gathered in Harare, Zimbabwe to launch the HIV Self-Testing Africa (STAR) Initiative, to date the largest study of its kind in three southern African countries.

At the time, HIV self-testing (HIVST) was little known in sub-Saharan Africa. HIVST products were too expensive and it was unclear whether HIV self-tests could be distributed efficiently and ethically. Not a single country in Africa had launched HIVST.

What a difference two years can make.

In taking HIV testing beyond the traditional clinic and into the household, HIVST is empowering those who may not test otherwise and reaching higher risk groups, including men, youth and key populations.

This World AIDS Day, we celebrate that momentum and recognize the hard work of Ministries of Health to integrate HIV self-testing in national policies, guidelines and programming. These efforts are crucial to making HIVST accessible and to accelerating the achievement of the United Nations’ global HIV prevention and treatment goals.

In Lesotho and Swaziland, the two newest countries in the STAR Initiative, national governments are taking strong steps in support of HIVST.

Today in Lesotho, the Ministry of Health launched HIV self-testing efforts with the release of guidelines and training materials, along with information, education and communication (IEC) guidelines. Over the next months, several thousands of HIVST kits will be distributed through a phased approach, testing several facility- and community-based distribution models.

Under the leadership of the Ministry of Health and the Swaziland National AIDS Program, HIVST was launched in Swaziland earlier this year. World AIDS Day celebrations in all four regions of the country promoted HIV self-testing as an innovation in the country’s HIV response, as reflected in the revised national guidelines on testing. Distribution of self-testing kits, in line with the new national standard operating procedures and training manual, will expand throughout the month of December. Kits are already available through fixed testing sites and will be available in workplaces, high volume facilities and through VMMC demand creation activities by the end of the month.

In Zambia, where over 172,000 HIVST were distributed under the first phase of the STAR Initiative, the Ministry of Health launched revised Consolidated Prevention and Treatment Guidelines emphasizing the importance of HIV self-testing. Development of an HIVST Operational Framework to inform the scale-up efforts was initiated. The Lusaka ART Surge Campaign, a part of UNAIDS Fast Track Cities Initiative, was also initiated with HIVST as a central component. This week, in the lead up to World AIDS Day, intensified HIVST distribution efforts were carried out in workplaces targeting adult men – who are not being reached with traditional testing approaches. Over 580,000 test kits will be distributed in Zambia in the second phase of the STAR Initiative.

Working in partnership with PSI’s New Start network, Zimbabwe’s Ministry of Health kicked off the national HIVST scale-up program with the distribution of HIV self-test kits – along with offering traditional provider testing – among key populations in a pre-World AIDS Day launch session in Bulawayo, the second largest city. This initiative will further facilitate equitable access to HIV self-testing for high risk groups, including men who have sex with men (MSMs), sex workers and other key populations, through consumer orientated distribution approaches. Over the next two years, Zimbabwe expects to distribute more than 600,000 HIVST kits, in addition to the more than 200 000 kits already distributed under Phase 1 of the STAR Initiative.

Over the next two years, the global community must support these ministries’ bold efforts at the country level. To ensure their success, national guidelines and frameworks must be accompanied by rapid scale up and implementation, continuous evaluation to identify the most sustainable, equitable and cost-effective approaches for HIVST distribution, along with the continued support of global donors.

Only through innovative approaches that bring HIV products and services closer to people, do we have the potential to reach those with unmet need and ultimately cover the last mile in the HIV response.

In 2020, let’s look forward to celebrating HIVST’s role in successfully closing the global testing gap. In 2015, that may have seemed an unreal aspiration. But the last two years have shown how fast we can make change happen.