Five years ago, hundreds of protesters took to the streets in Kenya in tribute to a murdered 15-year-old orphan boy, Isaiah Gakuyo. An uncle had apparently stabbed Isaiah with a pitchfork because the boy was HIV positive - the child’s mother and grandmother had both passed away from AIDS-related diseases.
As a UNICEF spokesperson put it at the time, “The stigma attached to children living with HIV/AIDS is really an untold story....It’s not only that they’ve been victimized by others outside their families. They are sometimes victimized by their own families.”
Stigma, as the sociologist Erving Goffman detailed in his classic book of that title, is a societal “mark” of inferiority based on local “morals.” The word originates from ancient Greece, and refers to deliberate cuts or brands marked on slaves, criminals and traitors in order to designate their low moral status.
The problem, of course, is that while stigma and shame can help enforce community values in a positive way - against, say, criminals - their power can also be grossly misapplied. In some Kenyan communities and in other parts of the developing world, this has meant making children who acquired a disease through zero fault of their own outcasts from society and even their own kin.
Now, a remarkable new tool for testing diseases has emerged to help fight against transmission of HIV from mother to child and, in the long run, one hopes, to soften lagging societal views of AIDS, disease and blame.
Please welcome the mChip. On July 31st, in the prestigious biomedical journal Nature Medicine, researchers announced that the first field trial of a new, cheap HIV test was a striking success, with accurate detection among a Rwandan population of both syphilis and HIV. 100 percent of HIV positives were correctly identified, with 1 false positive out of 70 samples, and 94 percent of syphilis cases were correctly detected, with 4 false positives out of 67 samples. Roughly 3 percent of Rwandan adults are infected with HIV.
While half-hour field tests for HIV and other diseases have been around for years, the standard testing method - called “lateral flow” - has not been consistently accurate across contexts and diseases. Throughout the developing world, instead, people rely on lab tests, which take far more time and are costlier. In Kigali, for instance, where the mChip was tested, patients would normally have to give blood at the local hospital, and results can take weeks.
The mChip is clear and shaped like a credit card, and is projected to run between 2 to 3 dollars per card, as compared to 4 dollars or more for a lateral flow test. Even more impressively, the mChip can, in theory, simultaneously test for up to 10 different diseases using a single drop of blood, with results in about 20 minutes. In other words, the mChip promises to be faster, cheaper, more accurate, and could simultaneously test for HIV, syphilis, hepatitis, gonorrhea, herpes and chlamydia, for instance.
As Samuel Sia, a biomedical engineer and one of mChip’s developers, told BBC News, “The idea is to make a large class of diagnostic tests accessible to patients in any setting in the world, rather than forcing them to go to a clinic to draw blood and then wait days for their results.”
Because of both the stigma of HIV testing itself and the logistical barriers to widespread lab testing, the mChip could be especially effective in testing for HIV in pregnant women and in preventing transmissions from mother to child. This, in fact, was the researchers’ intention. “An ultimate goal,” they write, “is to develop a device for infectious-disease screening of pregnant women located in remote areas to prompt early treatment.”
The remaining challenge confronting mChip’s developers is to now move, with investor help, from testing the product to rolling it out into the field at scale. As to how bumpy a process that will turn out to be, only the next few years will tell. What is certain is that while the global fight against HIV/AIDS is succeeding, the mChip is nevertheless sorely needed, and urgently so. By one 2010 estimate, only about a quarter of pregnant women in low or middle income nations currently receive HIV testing.
Perhaps, eventually, such cheap, simple field tests will not only reduce transmissions of diseases from mother to child, but may also make testing so routine that that those with HIV/AIDS and other diseases are no longer treated as morally inferior or blameworthy - that communities no longer imagine, in Erving Goffman’s words, that when it comes to HIV, the “person with a stigma is not quite human."