Inter Press Service - February 5, 1999
Dev Raj

Last month, Delhi State Minister for Social Welfare, Krishna Tirath shocked people working in the field of HIV prevention and control by announcing mandatory tests on all women and children residing in homes for the destitute. Although the announcement drew a storm of protests from the central government as well as non-governmental organisations, Tirath has so far shown no sign of withdrawing her proposals.

Said the director of the central government's National AIDS Control Organisation, J.V.R. Prasada Rao, "This is a violation of national policy - no compulsory HIV screening can be undertaken by anyone."

As the storm over the tests grew it turned out that posh, privately-run maternity homes have also been insisting on HIV tests for both prospective mothers as well as their husbands.

A survey of polices at the city's maternal homes conducted by the Health India Foundation (HIF) revealed that not only were the tests compulsory but in most cases the women did not even know what they were being tested for.

"Informed consent was conspicuously missing in most of the cases with the women trustingly subjecting themselves to a list of tests ordered by their obstetricians," said Anju Singh, coordinator of the HIF.

She said the owners of the maternity homes generally supported the tests on the ground that they did not wish to place the obstetricians and doctors they employ under risk although routine precautions are sufficient protection against HIV, she said.

"Some pleaded ignorance of NACO guidelines which clearly state that tests should be carried out only on a voluntary basis with appropriate pre-test and post-test counselling."

In a policy paper, the World Bank-funded NACO acknowledges that HIV is more than a "mere biological test and involves ethical, human and legal dimensions" and that "there is no public rationale for mandatory testing."

The document, in fact, goes on to say that mandatory testing could prove counter-productive since it could scare away a large number of suspected cases from getting detected and counselled.

Such pious statements are lost on private maternity homes. "The owners said they would continue to order tests and said they reserved the right to refuse to treat any pregnant woman whether HIV-positive or not," Singh said.

According to Gordon Alexander, chief of UNAIDS, "voluntary testing accompanied by counselling has a vital role to play within a comprehensive range of measures for HIV/AIDS prevention and support."

UNAIDS, however, also emphasises the importance of confidentiality which cannot be assured in either private maternity homes or in government homes for the destitute.

In fact, the Supreme Court recently pronounced that an HIV victim cannot claim the right to privacy or the right to marry while throwing out a damages suit filed by a doctor against a leading hospital chain for disclosing his positive status to his fiancee.

Dr Tokuga Yepthomi had also claimed in his case that doctors at the privately run, Apollo Hospitals were "under a duty to maintain confidentiality under the code of medical ethics."

"So long as the person is not cured of the communicable venereal disease or impotency, the right to marry cannot be enforced through a court of law and shall be treated as a suspended right," Justice Sahgir Ahmad said in November 1998.

Observed the widely-circulated 'Indian Express' daily in an editorial "This is an extremely deep matter, involving profound values such as individual freedom versus the state's need to protect people."

The editorial said "disclosure must be legally required but if in spite of it someone chooses to marry the law should keep out of it. Unless of course it can be established that marriage was forced."

Said Purushottaman Mulloli, of the Joint Action Council, Kannur (JACK), an NGO dealing with community empowerment and HIV, the ruling has the potential of undermining basic medical ethics.

"It is little wonder that the Delhi government has been emboldened to order mandatory testing on destitutes - and that may just be a beginning of bringing more groups under the net," Mulloli said.

The experience in this county so far has been that disclosures invite intense social opprobium not only for individuals but entire villages while the state remains helpless in providing any kind of relief by way of counselling or medication, he said.

Mulloli cited the village of Chochi outside Delhi which became the victim of a bizarre AIDS scare two years ago. "To this day people are reluctant to contract marriages with the residents of Chochi simply because one of its residents died of suspected AIDS," he said.

Such has been the controversy over the judgement that, last month, Prime Minister Atal Bihari Vajpayee felt compelled to issue a rare appeal to state governments to get people sensitised against socially ostracising HIV-infected people.

Vajpayee added to the plethora of pious statements: "Prevention and control of HIV/AIDS cannot be regarded merely as a public health issue. It has an essential socio-economic dimension and should be treated as a development issue involving all sectors of government and the community." (END/IPS/rdr/an/99)
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