Encouraging human immunodeficiency virus self-testing among vulnerable group of adolescents: A World Health Organization initiative

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Encouraging human immunodeficiency virus self-testing among vulnerable group of adolescents: A World Health Organization initiative. Ann Trop Med Public Health 2016;9:126-7


How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Encouraging human immunodeficiency virus self-testing among vulnerable group of adolescents: A World Health Organization initiative. Ann Trop Med Public Health [serial online] 2016 [cited 2020 Aug 13];9:126-7. Available from: https://www.atmph.org/text.asp?2016/9/2/126/177385

Dear Sir,

Adolescence is a crucial phase in the life of an individual comprising of major biological, social, and psychological changes. [1] In fact, out of every six people in the world, one is an adolescent (10-19 years) accounting for almost 1.2 billion of the human population. [1] The policymakers have given special attention to adolescents not only because of their sheer number but also because they are extremely vulnerable and are often out of school, get married early, become addicted, work under hazardous circumstances, are sexually active, and are exposed to different forms of violence. [1],[2] Further, it is extremely difficult to narrow down to a single reason for adoption of such high-risk behavior as multiple levels of parameters (operating at individual, family, community, and societal levels) eventually determine them. [1],[2]

Worldwide, human immunodeficiency virus (HIV) continues to remain as a major public health concern affecting the quality of life of millions of people. [3] As a group, adolescents are often extremely vulnerable to HIV infection, with acquired immune deficiency syndrome (AIDS) being ranked as the most common cause of death among adolescents in Africa and the second most common cause of death among adolescents worldwide.­ [4] The high rates of HIV-associated mortality among adolescents clearly suggest that most of them fail to receive the desired care and support services that are needed to ensure their survival. [1] Further, in the year 2014, almost 0.22 million new HIV infections were reported among adolescents, and at the same time in excess of 2 million adolescents are living with HIV worldwide. [2],[4] Despite of all these facts, a very small proportion of adolescents actually get tested for HIV in contrast to the number of adults who get tested for HIV worldwide. [1],[4]

The World Health Organization (WHO) has time and again emphasized for the need of quality assured HIV testing as it is considered as the gateway to HIV prevention, treatment, care, and other support services. [2],[3] However, the recent estimates suggest that only 10% of young men and 15% of young women are aware of their HIV status in the sub-Saharan Africa region. [4] These estimates are in accordance with the global estimates that suggest that only 51% of people living with HIV (as opposed to the goal of 90%) are actually aware about their HIV status. [5] Multiple reasons pertaining to individual attributes (viz., stigma and shame, denial, disclosure difficulties, poor education status, substance abuse, etc.), family parameters (like family dysfunction, history of past or current neglect/abuse, family or social support, lack of health care insurance, etc.), or health system characteristics (viz., accessibility, rigid timings, involved costs for HIV testing, presence of adolescent-friendly staff/services) have been identified that have prevented adolescents from seeking HIV testing worldwide. [6],[7],[8],[9]

In order to bridge the HIV testing gap, apart from suggesting various administrative reforms, strengthening of the health system, the WHO has come up with innovative approaches such as community-based HIV testing, lay reporter HIV testing, and even self-testing. [4],[5] Self-testing (with the help of fingerprick or an oral fluid rapid test kit – noninvasive) has attracted a lot of attention as it neutralizes the key barriers to HIV testing (viz., privacy and confidentiality concerns and dependency on the counsellor/health system). [5] It is very important to understand that self-testing is just a first test and cannot provide an HIV diagnosis on its own. Further, those people whose self-tests are reactive (might be infected with HIV), should seek for subsequent HIV testing at health establishments. [5]

In fact, almost all adolescent (16-19-year-old) girls and more than 80% of adolescent boys adopted HIV self-testing within a year of introduction in a community of Malawi. [5] Realizing the unprecedented results of HIV self-testing, it has been anticipated that it can assist nations in successfully reaching the United Nations’ target of making 90% of people aware about their HIV-positive status. [4],[5] Acknowledging the scope of HIV self-testing in improving the uptake of HIV testing services, different nations, including Australia, South Africa, China, the United Kingdom, and the United States of America have implemented it for various key population groups in their setup. [5],[10],[11],[12]

However, concerns about its misuse, self-harm, the absence of clear and comprehensive policies, and no global access to antiretroviral therapy (if found positive) have emerged as well. [10],[11],[12] Anyways, the initiative of HIV self-testing alone will not suffice and should be assisted by interventions such as the strengthening of the public health system, formulation of a comprehensive policy for self-testing, organizing community awareness campaigns to emphasize about the benefits of HIV self-testing, facilitating prompt access to appropriate prevention, treatment and care services, implementing peer or social network-based interventions to improve their uptake, and strengthening of the monitoring system to maintain the quality and supply of self-testing kits. [4],[5],[11],[12]

To conclude, HIV self-testing possesses an enormous potential in improving access of the general population, including adolescents, for ensuring early diagnosis of the disease. However, it is just the first step, and if we actually desire to improve the health standards of HIV-positive people, it should be ably supported with care, support, and treatment services.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.



World Health Organization. Adolescents: Health Risks and Solutions – Fact Sheet No. 345; 2014. Available from: . [Last accessed on 2015 Jul 19].
World Health Organization. WHO Calls for Stronger Focus on Adolescent Health. 2014. Available from: . [Last accessed on 2015 Jul 19].
World Health Organization. HIV/AIDS – Fact Sheet No. 360; 2015. Available from: . [Last accessed on 2015 Jul 19].
World Health Organization. Self-Testing Helps Combat HIV in Adolescents; 2015. Available from: . [Last accessed on 2015 Jul 22].
World Health Organization. Consolidated Guidelines on HIV Testing Services. Geneva: WHO Press; 2015. p. 1-13.
Mill JE, Jackson RC, Worthington CA, Archibald CP, Wong T, Myers T, et al. HIV testing and care in Canadian Aboriginal youth: A community based mixed methods study. BMC Infect Dis 2008;8:132.
Tanner AE, Philbin MM, Ott MA, Duval A, Ellen J, Kapogiannis B, et al. Linking HIV+ adolescents into care: The effects of relationships between local health departments and adolescent medicine clinics. J HIV AIDS Soc Serv 2013;12.
Petersen I, Bhana A, Myeza N, Alicea S, John S, Holst H, et al. Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: A qualitative investigation. AIDS Care 2010;22:970-8.
Johnson LF, Rehle TM, Jooste S, Bekker LG. Rates of HIV testing and diagnosis in South Africa: Successes and challenges. AIDS 2015;29:1401-9.
Kinney S, Lea CS, Kearney G, Kinsey A, Amaya C. Predictors for using a HIV self-test among migrant and seasonal farmworkers in North Carolina. Int J Environ Res Public Health 2015;12:8348-58.
Makusha T, Knight L, Taegtmeyer M, Tulloch O, Davids A, Lim J, et al. HIV self-testing could “revolutionize testing in South Africa, but it has got to be done properly”: Perceptions of key stakeholders. PLoS One 2015;10:e0122783.
Yan H, Yang H, Raymond HF, Li J, Shi LE, Huan X, et al. Experiences and correlates of HIV self-testing among men who have sex with men in Jiangsu province, China. AIDS Behav 2015;19:485-91.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.177385

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