The ongoing devastation wrought by HIV/AIDS is requiring governments to take bold actions to stem the tide of HIV and its resulting impact on citizens and society as a whole. Yet recent announcements in Botswana and Swaziland demonstrate a dangerous temptation for governments that are under extreme pressure. Officials in both countries are on the verge of crossing the line from aggressively proactive to dangerously rash.

The policies they are considering harken back to a darker period in the history of this epidemic in the US and Western Europe, a time when calls for extreme public health measures such as isolation, quarantine, and mandatory "this, that, or the other" led to confrontations between health officials and human rights advocates. Moreover, the news from Botswana and Swaziland conjures up hideous images of Nazi transgressions--perhaps history's most frightening example of where an extreme disregard for human rights can lead.

Botswana is reportedly introducing legislation that would require HIV-infected individuals to reveal their serostatus to sexual partners. Botswana's Health Minister Joy Phumaphi told the British Broadcasting Corp. last month that the new law would be part of the government's attempt to alter sexual behavior in a nation where an estimated 36 percent of 150 million residents are HIV-infected. While Phumaphi announced that a weekly counseling program would be launched to mitigate psychological issues, many HIV prevention experts fear the repercussions of such a mandate.

The most serious failure of mandatory partner notification is its deterrent effect on testing and treatment. A large body of evidence indicates that legislation of this nature has the opposite effect of what is intended. People avoid being tested because they fear the heavy stigma associated with HIV/AIDS. They also fear that they might be required to disclose information about their sexual contacts, and they suspect that the information about themselves and their partners will not be kept confidential.

On the other hand, voluntary programs that provide counseling to help HIV-infected individuals notify their partners are one component of effective HIV prevention and treatment programs worldwide. The International Association of Physicians in AIDS Care (IAPAC) and numerous other organizations have advocated on behalf of voluntary partner notification, recognizing the importance of this practice.

Admittedly, a mandatory partner notification program might reach some individuals who otherwise would have gone untested and thus untreated. But this limited "success" comes at a steep price. Not only do legions of people avoid being tested, but those who submit to testing subject themselves to the risk of discrimination and violence. Mandatory partner notification programs purport to shield the identities of both patients and partners, yet breaches of confidentiality are not uncommon. In countries where there is widespread panic about this disease, forcing people to reveal their HIV status will result in tragedy. And ultimately such legislation could pave the way for more extreme laws advocating quarantine or isolation camps. The government of Botswana cannot risk branding these people with the red ribbon of HIV when fear and ignorance have combined to create such a volatile environment.

A similar threat looms in Swaziland, where Tfohlongwane Dlamini, chair of the Swaziland National Council Standing Committee that advises King Mswati III, has suggested creating camps to segregate HIV-infected Swazis from the general population. Speaking at an AIDS conference held in Swaziland, Dlamini said HIV-infected individuals "should be kept in their own special place if we want to curb the spread of this disease." In concluding his speech, Dlamini described people with HIV/AIDS--25 percent of Swaziland's 1 million people--as "bad potatoes" who must be isolated else "all will go rotten."

This proposal should be exposed for what it is: a thinly veiled attempt to punish those whom Dlamini feels are morally inferior simply because the human immunodeficiency virus courses through their veins. Such Hitlerian measures are ludicrous in this day and age.

What does this all mean to IAPAC's members? It is a grim reminder that all of us who work within healthcare systems have a responsibility to foster greater respect for the dignity of human life--including the lives of people suffering from the parallel epidemics of poverty, disease, and social isolation. We cannot allow our healthcare systems to implement policies that deny dignity. Affirmative efforts are required to identify and uproot discriminatory practices so fundamentally in violation of basic human rights.

IAPAC's members--especially our physician members--must be activists for our patients' human rights. As the late Jonathan Mann once said, "to become a physician implicitly places us on the side of those who believe that the world can change. Every act challenges the apparent inevitability of the world as it is and the natural history of illness, disability, and death. ... At a profound, even instinctual, level--because it precedes rational analysis--people become physicians to struggle against the weight of human suffering, and thereby place themselves squarely on the side of those who intervene in the present, because they believe the future can be different."

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