Inter Press Service - October 21, 1999
Gillian Farquhar

The NGOs, who attended the hearing last week, have charged that instead of giving the Health Department more accurate statistics, preventing the spread of the disease and creating greater openness, notification would drive the epidemic further underground.

The health portfolio committee was hearing presentations on the department's draft regulations published for comment in April, but put on hold pending a review of all Aids programmes.

If adopted as proposed, the regulations will make it mandatory for healthcare workers to notify health authorities if they diagnose an Aids case -- but not give the name -- and also tell the person's immediate family.

But the biggest, most intractable obstacle to controlling the epidemic - stigma and misunderstanding about how the disease is transmitted - would result in more people living with Aids, especially women, being exposed to greater abuse if notification became law, opponents maintain.

"People with Aids feel afraid to disclose not because they want to harm others but because they fear rejection, stigma and in many cases violence," says Mark Heywood of South Africa's Aids Law Project.

He says: "It (notification) is a very uncompromising order from the government in a society where very few families have access to proper counselling or information about Aids, and where people living with Aids have no access to justice or protection."

Aids activist Gugu Dlamini, who revealed her HIV-positive status on television, was beaten to death in her home town of KwaMashu in KwaZulu-Natal on World Aids Day in December last year.

KwaZulu-Natal is the province with the highest rate of HIV-Aids infection, reaching 25 percent in some areas, while the national average is about eight percent. Nationally, there are an estimated 1,600 new infections daily, Morna Cornell, director of the National Aids Consortium, says.

"Attempts to prosecute non-disclosure are likely to lead into a quagmire. In the present climate of ignorance and hysteria, the potential for fostering fear and vindictiveness is immense," says Trengove Jones, an academic researching the history of Aids-HIV.

However, several political parties and the country's biggest labour organisation, the Congress of South African Trade Unions, among other, have given vocal support to the government's notification plan.

Other countries' experiences have shown that high profile unionists and political leaders - especially those themselves HIV- positive - could significantly influence people if they were open about their status and spoke out against stigma.

But, Aids activist Mark Decker says, there had been little more than lip service in this regard from such leaders in South Africa.

At last week's hearing, Heywood challenged ministers and high ranking government officials to declare their HIV status and set a new precedent for openness. The NGOs also refuted the government's argument that notification would help planning for the health service needs of people with Aids.

Decker, of the National Association of People Living with Aids, says stigma prevented infected people from going for counselling for fear of exposure. It was not uncommon for HIV- positive people to forgo both counselling and early treatment rather than risking their status becoming known.

If notification, which amounted to forced disclosure, become law, this would get worse, he says.

"We're only just beginning to break the stigma of HIV here. It (notification) will mean nothing but trauma. People are prepared to die rather than go for early treatment," he says.

But the government has argued that over-concern for confidentiality has stymied Aids prevention efforts in South Africa, claiming that greatest progress has been made in fighting the disease in African countries where confidentiality is less protected than it is in South Africa.

In these countries there is less stigma around the disease and thus violent backlashes are not as likely, opponents say.

Groups opposing notification say another way to achieve more openness is to launch a campaign encouraging voluntary testing, ensuring confidentiality and full protection against discrimination.

But government does not have the resources for such a campaign.

In KwaZulu-Natal, 60 percent of clinics did not have facilities for HIV testing, and more than 40 percent did not have a single health worker trained in HIV-Aids issues.

Fifty-six percent of all clinics in South Africa did not offer HIV testing.

Last week's parliamentary hearing also heard the view that making Aids rather than HIV notifiable would not help prevention efforts now as it would only provide information about risk groups and infection trends from five to ten years ago.

Some medical experts agree that, on technical grounds, there is little justification for making Aids notifiable. "From a public health point of view and from the point of view of prioritising resources (other than for care) such information is entirely unhelpful," says Dr Leslie London of the University of cape Town's department of community health.

"As anyone who has been involved in public health surveillance know, notification is fraught with inaccuracies, undercounting, overcounting, etc," he adds.

This would be exacerbated as the existing notification regulations allow for an Aids diagnosis to be made by any health worker - not just doctors - and on the basis of certain disease indicators rather than a laboratory tested blood sample.

Health Minister Manto Tshabalala-Msimang's spokesman, Khangelani Hlongwane, told IPS prior to the portfolio committee hearings that the notification plan was on track and that if there were changes they would be to procedure rather than to the principle.

Acting director general of the health department Dr Harm Pretorius, who sat in on the hearings, says the department would meet soon to discuss the hearings' report. "We're near a point where a decision will be made," he says.(END/IPS/gf/mn/99)
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