Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
South African Press Association - August 17, 2006
Cameron, himself HIV positive, said in an article in the latest newsletter of the South African HIV Clinicians' Society that Aids is now a medically manageable disease, and no longer a necessarily fatal condition.
Where possible, diagnosis should be a routine and uncontroversial element in the patient-management process, he said.
"Where the right conditions exist, we should therefore re-medicalise the diagnosis of HIV, by making it a normal part of medical treatment, subject only to a patient's deliberate and express refusal to be tested."
He said availability of antiretrovirals, freedom from discrimination and confidentiality of testing are still rare in Africa.
"But where they do exist, we must move urgently to normalise the treatment and diagnosis of Aids. It has already happened in Botswana, and we should follow suit.
"And where these conditions exist, we should even forgo insistence on pre-diagnostic counselling, despite its acknowledged educational benefits.
"Counselling should be retained provided that a health care facility is able to offer it without sacrificing the time and energy of its health care personnel. That time is urgently required for diagnosis and treatment of HIV."
It is true that Aids is a "dread disease", and that pre-test counselling assisted those with it to adjust to their condition.
But malaria, cancer and insulin-dependent diabetes were also potentially fatal, and no testing or counselling protocols inhibited 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," he said.
A commitment to "normalising" the medical diagnosis and management of Aids will save many lives in Africa.
Cameron also said many people preferred not to be tested, partly, he believed, because HIV diagnosis was treated as exceptional, and was "hedged around with fuss and palaver and hullabaloo".
The requirements of express and specific consent, and the insistence on pre-test counselling, might come at a direct cost in lives.
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