Jun 14, 2010

Mandatory Testing

A Livingstone High court declared mandatory HIV testing illegal and unconstitutional. The ruling stemmed from a case brought by two former soldiers who complained that that they were subjected to testing without their consent by the Zambia Air Force (ZAF), and as a result of their positive testing were dismissed.

This ruling is quite unprecedented and adds another interesting layer in the ongoing discussion about whether or not HIV testing should be made mandatory especially in areas such as Zambia where the prevalence of the disease stands at 14 percent.

There is still stigma attached to HIV/AIDS that makes life difficult for the people that test positive, as well as their families and this acts as a deterrent for getting testing. There are obvious benefits for getting tested – it allows one to start treatment sooner if the results are positive and thus prolonging life.

An effective system needs to have the critical components of fully informed consent, confidentiality, and counselling. Until those elements co-exist testing levels will remain low, and implementing mandatory/compulsory standards will not reverse the trend.

Focus needs to be placed on education. Not everyone understands the benefits of being tested, and this ignorance kills.

-     Prenatal health care provides a unique opportunity to provide life-saving information about HIV to many people. For expectant mothers if found positive there is need to adopt better diets and treatment to minimise the risk of mother-to-child transmission of the virus.

The role of the father in this situation cannot be over emphasised, and there should be counselling for both before and after testing. The burden is often borne by the mother and unfairly places blame on her for infecting her child and sometimes her partner, as well.

-     If informed consent is not sought or given, and the understanding is that people get tested against their will, there may be a backlash. People will not seek medical attention for simple ailments for fear of being tested and this may prove detrimental for public health. We already have a culture of poor health service utilisation resulting from poverty and limited access, and it could possibly worsen with people dying from cases of untreated malaria, botched unattended home births and the like.

-     We need to get back to the messaging from the 1980s and 1990s – “Stop Grazing”. This called for behaviour modification – moving away from the practice of multiple partners. Unfortunately this was sacrificed at the altar of more condoms for Africa. This was a flawed decision on the part of donors and government officials.

And to round this out, access to ARVs also needs to be improved as a means of providing hope and treatment.  If we educate people fully of the benefits of being tested and behaviour modification to reduce the risk of contracting or spreading the HIV but do not have adequate treatment, it undermines the message.

We have come a long way in the last 5-7 years, and more is yet to be done. Having HIV does not have to be death sentence anymore. People can remain productive longer – working, raising families, etc and this aids a country in the short and long term. We’ve seen anecdotal and research findings about the loss of time and productivity experienced by employers when employees are constantly sick; it hampers progress. With effective treatment, this is minimised and we are able to keep the most productive longer! 


I offer some thought son this issue here. Though my preoccupation is much with the central controversy of whether it is a human right or not.

But going beyond that, I agree especially with the need for more education. It seems certainly that is where the great focus ought to be.

Chola, I am glad you chose to focus on the issue of human rights with regards to mandatory testing. I opted not to touch it because I am not that well versed in it, and I am still on the fence. I don't think I am in a position to make a compelling in either direction.

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