Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
Mail & Guardian (Johannesburg) - May 16, 2006
Belinda Beresford
In a speech that is already stirring heated debate, Cameron suggested that in some circumstances pre-test counselling should be dispensed with, provided that people having tests were assured of confidentiality, non-discrimination and anti-retroviral treatment.
Speaking at the Ronald Louw Memorial Lecture at the University of KwaZulu-Natal last week, Cameron said that making HIV-testing a routine part of medical check-ups would reduce the stigma and fear surrounding the virus and its diagnosis, as well as relieve the strain on healthcare workers.
Ethical guidelines currently enforced by the courts demand that anyone having an HIV-test must receive both pre- and post-test counselling, and give explicit consent. No other test for a pathogen or medical condition is hedged by such protections.
The counselling requirements apply to repeated tests, a factor which has been criticised by doctors as a deterrent to testing and a waste of healthcare resources. HIV-test results are confidential and one can almost never be forced to have a test.
Counselling is intended to reduce the fear and shame of people newly diagnosed with the virus, and provide an opportunity for education on how to avoid catching or transmitting HIV. The exceptional nature of HIV-tests stems in large part from the stigma surrounding the disease.
But Cameron argued that the special conditions around HIV-testing reinforce stigma and discourage many people diagnosed with Aids from receiving treatment. Ronald Louw, a law professor and Cameron's close friend, had his first HIV-test just seven weeks before he died of an Aids-related illness.
He said the advent of mass anti-retroviral therapy through the public health services should lead to the normalisation of HIV.
"It is true that Aids is a dread disease ... But malaria, cancer and insulin-dependent diabetes are also dread, potentially fatal, diseases. Yet, no testing or counselling protocols inhibit their diagnosis and effective management.
"In a mass epidemic of HIV, where mass treatment is now a realisable fact, pre-test counselling may be a luxury we can no longer afford. Our commitment to normalising Aids must include a commitment to equate its medical diagnosis and management with that of other treatable dread conditions."
Recently Cameron reinforced his call: "I believe the Health Professions Council, one of the main sources of judicially enforced ethical norms for healthcare workers, should convene an urgent meeting to reconsider current restrictions on HIV-testing."
One critic of Cameron's approach is Mark Heywood of the Aids Law Project, who said that while people should be encouraged to test for HIV, Cameron was "trying to de-exceptionalise, when HIV remains an exception. For most people, HIV diagnosis remains full of dangers and access to treatment is far from guaranteed." Rather than bring HIV-treatment down to the level of that for other illnesses, it is other illnesses that should be given the importance accorded to HIV, said Heywood.
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