Inter Press Service - September 15, 2004
Zarina Geloo

As a draft national AIDS policy is still under discussion, lawmakers have yet to finalise their position on the matter of testing.

However, the National AIDS Council (NAC), which co-ordinates the activities of all organisations working to combat HIV, has announced plans to place at least 100,000 people on anti-retroviral therapy by 2005 - and called for mandatory HIV/AIDS testing in hospitals and clinics to form part of the programme.

This provoked a storm of protest from activists and people living with AIDS, who claim that compulsory testing is an abuse of human rights - flying "in the face of civil liberties".

Kunima Banda from the Network of People Living with HIV and AIDS says mandatory testing would cause people to avoid going to hospitals when in need of treatment.

Instead, "The way to go would be to scale up VCT (voluntary counseling and testing) so that it is always voluntary, and people will be properly prepared for their results," she adds.

A former health minister, Nkandu Luo, has added her voice to the chorus of discontent.

She notes that more work needs to be done to ensure Zambia's health facilities are fully capable of dealing with the AIDS pandemic - and that introducing mandatory testing before this has been achieved would be impractical.

Luo, who has just conducted nation-wide research on the availability of VCT sites in the country, says clinics have insufficient ARVs and that they suffer from inadequate training of medical personnel in dispensing drugs. In addition, testing and counseling services are not up to scratch.

While people in outlying areas may want to get tested for HIV, the facilities that could enable them to do so are often located too far from their communities. Those who succeed in visiting a clinic may find that testing kits have run out - and that information on how to access anti-retroviral drugs (ARVs) is sketchy.

In fact, Luo says, the general lack of information about the pandemic means that many people still think of HIV and AIDS in terms of witchcraft: "In this scenario, how can government want HIV screening to be mandatory? (We need to put) first things first: information and prioritization of resources, so that systems and facilities are in place (with) support for people on ARVs, (like) good diet and counseling."

Maybin Kumwenda who tested HIV-positive in 2000, says part of him still wishes that he did not know his status, as this knowledge has brought him a lot of sympathy - but little in the way of tangible benefits.

Like many Zambians, Kumwenda is poor and cannot afford ARVs, even those subsidized by government. Although he should be keeping his health up by having three square meals a day, this isn't always possible.

"I see many people in my shoes...I do not think mandatory testing is the way to go in the absence of a strong social support system," Kumwenda notes.

But health officials view things differently.

A doctor, Gregory Manda, says an initial burst of public enthusiasm when VCT centres opened has been transformed into a slow trickle of people wanting to be voluntarily screened for HIV.

He adds that sensitivities around HIV testing have also created the bizarre situation where medical staff who suspect that a patient may be HIV-positive nonetheless test for a variety of other ailments first - a process of elimination that is exhaustive, expensive and time-consuming.

"Because of this human rights and liberties fear that surrounds HIV we leave HIV testing as a last resort when it should be first, and the patient should be told and counseled on admission. That way, the patient is treated quickly and there is a minimum wastage of resources on unnecessary tests," says Manda.

He notes that a more direct and unembarrassed approach would also be to the advantage of medical personnel - whose behaviour is affected by attitudes towards HIV and AIDS.

"Can you imagine if a patient who has been in the hospital for some time, suddenly finds medics treating him with extreme caution because they have just discovered his HIV status?...It is happening now in our institutions; people do not need to be told their status - it shows in the different way they are treated once tested."

Nurse Suzgyo Mukande also believes that, while VCT would be the best option, government needs to take an unpopular position on this matter for the general good.

"We have a VCT centre in the hospital grounds but few people make use of it - only those who are very sick and have been coerced into testing," she says.

Mukande believes that if every single person who visited a health centre was informed of their HIV status, there would be a reduction in hospital bed occupancy - and in the cost of diagnosing and treating illnesses.

This would free up funds to provide additional resources for the health and safety of medical personnel, she adds. At present, items like disposable gloves, needles and protective sheeting and disinfectants are always in short supply.

"If HIV testing is mandatory, government would in turn be obliged to scale up services in health institutions. It would also mean a re-focus on the entire health sector with more resources both in personnel and funds," says Mukande.

Decision-makers in other spheres have gone ahead with mandatory testing, even though this flies in the face of the 'Southern African Development Community Code of Conduct on HIV/AIDS and Employment' - which explicitly forbids compulsory AIDS tests in the workplace.

The Konkola Copper Mines conglomerate, for example, has stated that its miners will be screened for HIV to enable the company to formulate a comprehensive health policy for employees. Zambia's Ministry of Defence has also decreed mandatory testing for new recruits.

Current minister of health and retired soldier Brian Chituwo has since been put in the awkward position of agreeing that mandatory testing does clash with civil liberties - while defending government's decision to screen its troops.

Manda says that Chituwo's statements speak volumes about the confusion on this topic: "There is no consensus in government."

040915
IP040912

Always watch for outdated information. This article first appeared in 2004. 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, 2004. 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. .