From Beatrice Akua Asamani, GNA Special Correspondent, Maputo

Maputo, July 21, GNA - An international HIV/AIDS expert, Dr Ernest Darkoh has encouraged Ghana to implement an aggressive national HIV/AIDS testing programme to get every individual to know his or her status for timely utilisation of prevention, care and treatment interventions to prolong their lives

He said getting people to do the test should be close to mandatory because it would be catastrophic for people to know their status only when they were very sick and dying, adding that between 75 per cent and 90 per cent of the population did not know their HIV status. Dr Darkoh observed: "If the 2.7 per cent HIV/AIDS prevalence was a true reflection of the situation, Ghana has a tremendous opportunity to basically eliminate the disease as an epidemic and become one of the first countries to make history with HIV/AIDS.

"And the only way it can achieve this is to literally get every able-bodied person living in Ghana to get tested; know the HIV status today; and simply prevent getting infected tomorrow." He said policy makers; Government and health workers would also be able to plan, budget and provide the requisite solutions if they knew the actual scale of the problem.

Dr Darkoh was speaking in an interview with the GNA after leading an expert discussion on the impact of the disease on Africa's economies and development prospects, as part of this year's CNN Multichoice African Journalist of the Year Awards ceremony, in the Mozambican capital of Maputo.

Sub-Saharan Africa remains the worst affected Region in the world, with 24.5 million people living with the virus representing 64 per cent of the global figure of 39 million people. With 33 per cent; Swaziland has the highest prevalence in the region and Cote d'Ivoire topping in West Africa with a prevalence rate of 7.1 per cent.

Dr Darkoh noted that Ghana's estimated prevalence was low and within striking range as compared to African countries with 40 per cent of their adult population or 20 per cent of their entire population living with the disease.

However, it would be imprudent for Ghana to take comfort in the seemingly low figure because of its potential to grow into an alarming level, warned Dr Darkoh, a US citizen with Ghanaian parentage, who is credited with developing and managing Botswana's National Antiretroviral Treatment Programme.

He is now the Chairman of BroadReach Healthcare, a South African-based company, which provides innovative and healthcare delivery models and treatment programmers for HIV/AIDS.

The National AIDS Control Programme recently put Ghana's HIV/AIDS prevalence at 2.7 per cent from 3.2 in 2004 based on its sentinel survey of pregnant women receiving antenatal services at some clinics and men reporting to clinics with STDs. But the UNAIDS' 2006 report on Ghana says infection levels among antenatal attendees rose to nearly four per cent in 2005 though national prevalence was estimated at 2.3 per cent.

To prevent the silent epidemic from getting out of hand, Dr Darkoh said persuasion and effective counselling services should precede the mass-testing programme, which should be structured in a manner that would eliminate fear, guilt, judgment and exclusivity so that people would find it very normal and beneficial to take it.

"A knowledge status card, which does not bear the result, could be issued to those tested and this could be demanded when accessing certain basic public services," suggested the expert, who serves as advisor to governments across Africa, Asia and the Caribbean. . "The objective here is not to tell others whether you are positive or negative but basically to just let you know your own status and for them to know that you know," he explained, adding that the issue of stigma was overstretched since more people with the disease received support and care from their family than the number rejected. "We hear more about the negative cases but there are thousands of families who stick with their sick relatives no matter how sad and difficult the situation."

Dr Darkoh said encouraging group testing on population basis, such as having all employees in an organization or in a community or all parliamentarians taking the test together was better than putting the burden on individuals to go for the test and justifying why they had to. Additionally, it should be possible for people to be tested each time they visited a health facility as a routine procedure no matter the ailment they reported with. "Without testing everybody walks around presumed negative unless proven positive and this is a bad and faux state to be in when dealing with an epidemic of that potential," he stated.

Alongside testing, he said, there should be an efficient and workable IEC programme with well researched and need driven messaging for people who were either positive or negative.

He said, "people should know the right places to go for counselling, testing, care and treatment and what times these services are available; when people test negative they should know that they are part of the programme to keep them perpetually negative and when they test positive they should know they are part of the programme to keep them healthy and to avoid spreading the infection. "The positive ones who get to know their status early enough, should receive care and psycho-social services and they should also be helped to deal with nutritional and wellness issue, indeed they should know about what research and help is available in the future... all these are benefits of testing."

He added: "If those who are positive get to know their status in good time they would not need treatment immediately, but they could prolong their lives by about five years by doing the right things after which treatment can extend it by another seven to ten years. However, those who CD4 body count falls around 200 and below would need immediate treatment and they should have been equipped with the information on what treatment is available, where treatment is available and when treatment is available because sick people can not afford to spend their money and low energies in search such services. Dr Darkoh said adherence to treatment was the most challenging issue once patients start treatment because they were obliged to continue till the end of their lives.

"There should, therefore, be monitoring of patients to see if they are taking their drugs consistently as prescribed," he said. On messaging aimed at abstinence and prevention, he said, studies had to be undertaken to identify and understand the basis of where risk was coming from and where all the different entry points for potential HIV/AIDS infection were in the population.

To achieve this, the expertise of social scientists and people with vast knowledge and understanding of their populations, such as traditional and local leaders, had to be tapped to effectively achieve the desirable behaviours, actions and attitudes. In most cases, messaging, Dr Darkoh said, had to transcend beyond slogans, T-shirts and stickers to providing services or incentives to distract people from their set negative behaviour patterns that promote infection.

"For instance, young people could be engaged in sporting activities after school, while less endowed communities could be given television sets or community entertainment as sources of recreation. Additionally, social scientists and marketing professionals could be used to design innovative and tailor-made campaigns that are appealing to specific populations, thus making the use of condoms as desirable as drinking coca cola or trendy as wearing designer clothing. He said health professionals and care providers who failed to deliver had to be held accountable, while those who embezzled funds for HIV/AIDS be prosecuted with the seriousness attached to other crimes. 21 July 06