This is not a test: Why health equity matters in improving access to HIV testing

A test is a test, right? I’ve struggled with the issues of why HIV testing matters over the last 25 years, and over that time I’ve seen the ebb and flow of debates and discussions on why testing is still an important issue for Canada. I’ve also seen the frustration among those who do not have access to testing and why that matters. Yes, knowing your HIV status is still an important health issue for Canadians. However, with the complex array of debates on the pros and cons of testing, including the very real concerns about confidentiality; the need for pre- and post-test counselling; limited access to testing innovations such as point-of-care testing (POCT); the gendered nature of testing along with some popular misconceptions about it, there is definitely room for improvement moving forward. Simply put: We can and must do better in our national leadership around HIV testing issues in this country.

A framing of HIV testing through a health equity lens can, I believe, help to ensure our approaches to testing do not further the disparities faced in access. As stated in the Canadian Public Health Association’s Sexually Transmitted and other Blood-Borne Infections, including HIV, (STBBI) Health Equity Impact Assessment (HEIA) Tool, health equity refers to “the absence of health disparities between groups even though they are differently advantaged according to the social determinants of health; reducing the barriers that result in health disparities leads to health equity”. From a health equity perspective, addressing gaps in our current approaches to testing is urgently needed in an effort to tackle the key, intersecting determinants of health that can negatively impact our health, including gender, age, education, etc.

As we prepare for Aboriginal AIDS Awareness Week and World AIDS Day 2015 events and activities, I am reminded of the challenges we have yet to overcome in our own country. Challenges in relation to who can access HIV testing, the type(s) of testing available (noting that as of 2015, there is still no access to HIV POCT in any of the four Atlantic provinces), where individuals can access testing, when testing is offered and why. This year on December 1^st the National HIV POCT Working Group will be launching the National Action Plan on HIV Point-Of-Care-Testing, which is a call to action in the form of a user-friendly advocacy document which can be used to help frame the unique, context-specific testing issues communities still face in 2015.

The National Action Plan on HIV POCT offers 10 key recommended actions that outline how we can all play a part in making these proposed changes happen over the next five years, in the hope that by 2020 we will be able to mobilize for change at the national level. Key actions include increasing access and awareness of the importance of HIV POCT; providing training and education to health professionals; promoting standardization of POCT in Canada; and strengthening collaboration between urban, suburban and rural POCT sites. We believe that these actions, as recommended by the National Working Group on HIV POCT and others, will help us to push for greater national leadership in the areas of access to and uptake of innovative testing approaches like pop-up testing sites in rural Canada, and innovative technologies such as multiplex testing (testing for more than one infection at the same time, like HIV and hepatitis C), or home testing.

The issues around HIV testing are complex, and vary from location to location, population to population, and from community to community. Bringing a health equity perspective to this issue, we believe, will help create the changes needed to ensure that the next generation of testing approaches not only ensure that counseling, confidentiality and consent are adhered to, but also that we do this with an eye to addressing the key barriers to testing, including access, social stigma and marginalization.

The HIV Point-of-Care Testing (POCT) in Canada: Action Plan 2015-2020 full document is available at http://www.dal.ca/diff/gahps/whats-new.html.

Jacqueline Gahagan, PhD is a Full Professor (Health Promotion) and Head of the Health Promotion Division at Dalhousie University. Jacqueline is also the Director of the Gender and Health Promotion Studies Unit (GAHPS Unit), and holds research associate positions with the European Union Centre of Excellence, the Health Law Institute, the Beatrice Hunter Cancer Research Institute, and the Atlantic Health Promotion Research Centre. Jacqueline has been involved in HIV/AIDS advocacy, activism and research for over two decades and was awarded the Queen Elizabeth II Diamond Jubilee Medal in recognition of her work in the field.