WHO Proposal for Mandatory HIV Screening in Sub-Saharan Africa Draws Fire

The recent proposal of the World Health Organization (WHO) to test everyone for HIV every year in hard-hit areas like sub-Saharan Africa has drawn fire. Putting everyone who tests positive on AIDS drugs raises serious problems, it is argued.

The move perhaps could slash dramatically the number of new infections, because AIDSs drugs lower the levels of virus in the body, making HIV transmission through unprotected sex much less likely.

But the strategy, expounded in a paper published online by the Lancet medical journal, raises major issues both over implementation and over ethics.

The authors of the paper include Kevin de Cock, HIV/Aids director at the WHO, who points out that this is a mathematical model for discussion, but says it offers hope at a time when other avenues appear to have closed. If this could be implemented in sub-Saharan Africa, he told the Guardian, "the proportion of people with HIV would run to under 1% in less than 50 years".

Prospects for a vaccine against HIV infection have slumped after a number of failures, particularly the halting last year of a trial by the pharmaceutical company Merck around which there had been great optimism. Microbicides - virus-killing gels that women could use before sex - have also failed to produce results. The biggest and best achievement in sub-Saharan Africa so far has been the roll-out of antiretroviral drugs, which are now keeping 3 million people alive, notes Sarah Boseley, health editor of the Guardian.