"TESTING FOR HIV IS MORE THAN A MERE BIOLOGICAL TEST"
India is increasingly getting into the grips of a division over mandatory HIV testing versus voluntary HIV testing.
Last month Karnataka state in India had proposed mandatory HIV testing for couples. This month in April 2007, another state of India (Andhra Pradesh) came up with mandatory HIV testing before marriage. Also Goa had proposed mandatory pre-marital HIV testing ‘by law’ in April 2006.
But will mandatory HIV testing alone reduce the new HIV infections? Public health experts disagree. “We need to raise awareness about HIV, reduce stigma associated with HIV, especially stigma within healthcare settings which keeps people away from accessing these services (which are often life-extending and also contribute towards prevention), strengthen primary healthcare services and raise sensitivity to the issues of confidentiality and dignity of life of those living with HIV” said noted health rights’ advocate Jashodhara Dasgupta of SAHAYOG (www.sahayogindia.org).
The paramount progress we have made in terms of NOT thinking about prevention and treatment in isolation is at risk to be lost with Indian states promoting HIV prevention strategies completely ignoring the treatment, care and support provisions for people living with HIV.
Andhra Pradesh Chief Minister Y S Rajasekhar Reddy on 17 April 2007 said that (Source: Rediff News: http://www.rediff.com/news/2007/apr/17ap.htm) "I fail to understand the reasons behind the objections raised by some human rights activists on the government's initiative for making HIV/AIDS tests mandatory for couples before marriage.”
India has never been on such a HIV control crossroad with people divided over mandatory HIV testing versus voluntary HIV testing.
What human rights’ advocates will like to tell Dr Reddy is that the impact of HIV positive diagnosis on an individual’s life is enormous. The triad of stigma, discrimination and denial associated with HIV, thwarts an individual’s life in a myriad of ways. What are the plans for people who test HIV positive? Will they be left to face life without having access to even the primary healthcare services? With complete disregard to NACO’s (National AIDS Control Organization) confidentiality guidelines, the HIV positive status becoming a public knowledge in the to-be bride and groom’s communities, are we prepared to meet the healthcare needs of these people who test positive, and to ensure that they will not be forced to lead a life adversely impacted by HIV associated stigma, discrimination and denial?
United Nation's HIV Programme official said that the State has to think again as mandatory HIV testing will prove to be counter-productive. He said that it not only violates privacy but also stigmatizes the entire family, and also ‘tends to create a black market in false HIV test results’.
Senior Advocate Colin Gonzalves said that "any mandatory testing is wrong. Couples should rather be counseled and educated," adding, "If they want to get a testing done by choice after that, it's their business. But a mandatory test can't be imposed on them".
NACO guidelines say that “Testing for HIV is more than a mere biological test for it involves ethical, human and legal dimensions. The government feels that there is no public health rationale for mandatory testing of a person for HIV/AIDS. On the other hand, such an approach could be counter productive as it may scare a large number of suspected cases from getting detected.”
HIV Testing by itself does not result in behavioural changes that restrict transmission of HIV to others and therefore, testing should be a part of the comprehensive control programme which is conducive for behavioural change of the individual by providing social support, means and skills to reduce or eliminate risk behaviour. NACO official further adds that “Otherwise such testing can drive the target people underground and make it more difficult for launching intervention.”
As access to antiretroviral treatment is scaled up, there is a critical opportunity to simultaneously expand access to HIV prevention, which continues to be the mainstay of the response to the HIV epidemic. Without effective HIV prevention, there will be an ever increasing number of people who will require HIV treatment. Among the interventions which play a pivotal role both in treatment and in prevention, HIV testing and counselling stands out as paramount.
The current reach of HIV testing services remains poor. The reality is that stigma and discrimination continue to stop people from having an HIV test. To address this, the cornerstones of HIV testing scale-up must include improved protection from stigma and discrimination especially within healthcare settings, as well as assured access to integrated prevention, treatment and care services.
Just earlier this month, a pregnant woman with HIV died after being denied medical attention in Indore. Undoubtedly public health strategies and human rights promotion are mutually reinforcing. It is clear that India has a long way to go before we have a public health system strong enough to deliver effective healthcare to most underserved communities. And mandatory HIV testing alone is certainly not the short-cut.
(The author is a senior health and development journalist writing for newspapers in Asia, Middle East and Africa. He can be contacted at: firstname.lastname@example.org)
DECCAN HERALD, Bangalore, Karnataka: 3 May 2007