TNT = Test aNd Treat

One of the burning issues that received a lot of pros and cons from the community is the Test and Treat Project, or more popular known as TNT. The scientist believes that this new prevention method, that was based on a mathematical model, will eradicate HIV if applied in a large scale. Researchers are planning to set the trial in two years and it will be involving around 40,000 people as participants in South Africa. Half of the research participants will get immediate treatment when they are tested positive, while the other half will have to wait until their immune system deteriorate at certain level before being put on a treatment scheme. The experiment is designed to see whether starting early treatment will reduce or eliminate the transmission or not. This methodology is assumed to be able to reduce the infection rate up to 95%.

United States of America is planning to carry out the TNT Project in Bronx, Washington DC and Manhattan, as those areas are seen as having highest rate of HIV infection in the country. In Washington, D.C., where about 5% of adults are estimated to be HIV positive--and up to one-fifth of those may not knew their HIV status--only around half of those who were diagnosed in 2006 pursued medical follow-up within six months’ time. That delay can mean the difference between years of healthy living with the proper combination of medications, or poorer health and an earlier death. It also creates a larger window of opportunity for the virus to passed on to others.

However, the plan was not applauded fully by the community. Many of them are still hesitant and even strongly believe it is not the best way to solve the epidemic issue. „I do not agree with this project because this is merely just another form of mandatory testing. And there is no opt out while treatment provision is not sustainable.“ Meena Seshu from India strongly addressed her opinion. She said that there is no adequate support mechanism in her country and treatment is not accessible.

On the contrary, Greg Gray, the Drug User and MSM Campaign Coordinator from World AIDS Campaign thought that the idea is great, but there are many other factors that needs to be considered. „How do we ensure that the human rights of the patients are going to be protected? That is the big question which going to be addressed by a lot of people, because we know that confidentiality and proper counseling are still the challenges around testing.“ Greg thought, conceptually and theoretically it is a great and logical method that fits economically. Because while the initial investment is huge, for the long run it will be considerably a lot cheaper than other prevention methods offered so far, so the investment will be worth it. Everyone knows that treatment provision is a form of prevention, but it needs to be endorsed by other forms of support as well. We need to consider the mental preparedness of the people. Social supports such as job security, housing, sustainable income, proper psycho-social counseling and access to treatment are very important to be in place.

„Accepting HIV status is not an easy thing to do. if people do not have psycho-social support, it will have negative impact on the society. And we do not want to see more HIV-positive people getting into depression.“ said Greg.

Mei from Indonesia explained that her country is not ready for this project. Furthermore, a lot of discussions had been conducted in the national mailing list and most of the feedback was negative. Many activists in Indonesia seen it as a repackaging of mandatory testing or a way to make mandatory testing politically correct. Another concern from her was treatment provision and adherence in Indonesia. „If this project is carried out, I am afraid there is going to be a huge wave of people going for treatment coming. In the mean time, treatment provision in Indonesia is very unsustainable. We are struggling because the supply of medication is uncertain.“ Furthermore, she explained, the adherence level in Indonesia is considerably low. If this project is carried out and the quality of adherence is not good, the number of people who get drug resistance will increase rapidly and second line ARV will have to be provided. Indonesia is still fighting for certainty of the first line, let alone the provision of the second line. „While we can see that theoretically this is a good methodology, practically, it is difficult. The government will be hesitant to invest and the possibility of drug resistance will be a big problem for our country.“

Every aspects in our lives has to sides. The good side and the bad side. There are still a lot of aspects to consider before we step into the project. Human rights is one of them. The loss of opt out in this project will be seen as human rights violations which will create another pressure from the community. And it is important to remember that what is presumably applicable in one region may not be ideal in others. So, more flexible and sensitive approaches are essential.