Index Testing: Advocates call for action

January 30, 2020

This update contains background information and an action alert on index testing. While this approach to HIV testing (see below for a definition) has potential benefits for individuals and communities when it is done ethically, with consent and without coercion, it can also be aggressively implemented in ways that can cause harm to individuals, undermine their rights to consent, privacy, safety and confidentiality, and can erode the trust of communities with health care providers.

Download an FAQ with background and opportunities for advocates to engage.

This is a rapidly evolving area of discussion with the PEPFAR Office of the Global AIDS Coordinator (OGAC), country teams, CDC, USAID and other partners. For activists and advocates attending PEPFAR in-country retreats—here are some top-line concerns and demands to consider, discuss and push for:

  • All index testing programs should be immediately paused while risk mitigation and mediation efforts are put in place. Civil society rejects any PEPFAR guidance that only key populations (KP) programs need to deal with this issue or that index testing is only halted for members of KPs. Many key populations test in general population health facilities where disclosing their partners may risk discrimination and violence. Cisgender women and adolescent girls and young women (AGYW) face equally high risk of adverse events related to index testing. Their needs will not be met by KP-specific interventions.
  • Targets that set a percent of HIV-positive individuals that must be identified via index testing cannot be part of Country Operational Plans (COPs) for 2020. These targets apply pressure to programs and implementing partners, and send the message that the target matters more than the quality of service and the rights of patients. Moreover, such targets can’t be set while index testing is paused and remediation is underway.
  • Civil society must be involved in the development of the certification processes for restarting index testing and in the implementation of monitoring. Civil society partnership in providing support and monitoring is needed on an ongoing basis and should be a part of COP2020 budgeting for index testing programs.

Please reach out with questions, contact us if you have reports of harm, and join us in action.