Mail & Guardian (Johannesburg) - June 23, 1995
Justin Pearce

This follows a complaint by an outraged patient who recognised that routine testing was contrary to Health Department policy and World Health Organisation guidelines. The Aids Law Project at the University of the Witwatersrand has also been considering taking the hospital to court to end the policy of routine testing.

The matter was brought to the attention of the Aids Law Project and the Mail & Guardian by Ruth van der Vindt, who took her 22-month-old son Jude van Wyk for a minor hernia operation at the hospital.

Van der Vindt was appalled to see a sign in the paediatric section warning: "Aids is a reality. It is therefore the policy of this department to test patients for HIV infection when clinically indicated. If you have any objections to this policy, please inform the doctor in charge."

The same sign is displayed in several other departments. The orthopaedic surgery department displays a more detailed set of rules, including the provision that "patients who refuse to be tested should be treated as HIV positive", and that in certain instances a principle of "no test, no operation" should

Quarriasha Abdool-Karim, director of the government's HIV/Aids and Sexually Transmitted Disease Programme, said general screening for HIV is not Health Department policy. "It is not cost-effective or valid to test everyone," she said.

She said that tests should be conducted only in cases where the result would have an impact on the clinical management of the patient -- and then only with the consent of the patient, and pre- and post-test counselling for the patient.

Zackie Achmat of the Aids Law Project expressed the concern that with hospital signs only in English and Afrikaans, patients who cannot read in those languages could find themselves confronted with an HIV test with no prior knowledge of the test or its implications.

Superintendent Odes agreed that the signs were not valid. He confirmed that hospital staff should conduct HIV tests only with the informed consent of the patient, and after considering the case individually rather than as part of a general procedure.

"Aids is far too sensitive and emotional an issue to bandy around on signs."

Odes was surprised to hear about the sign in the paediatric department, saying that the "no test no operation" principle could not be supported.

Arguments favouring compulsory testing for patients cite the need to protect surgeons from HIV infection -- particularly in the case of orthopaedic operations which involve splintered bones and copious blood.

However, Odes said that there were precautions which ought to be taken when operating on any patient regardless of HIV test result -- but these precautions are not universally applied.

A new HIV infection is followed by a "window period" during which a patient may test negative but can still pass on the virus. Consequently, a negative test result should not be interpreted as a sign that the surgeon cannot be infected from the patient.

950623
MG950605

Always watch for outdated information. This article first appeared in 1995. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1995. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .