Deccan Herald
Bangalore, Karnataka
3 May 2007
HIV TEST
The bigger picture
By Bobby Ramakant
[The test must be part of a comprehensive rehabilitation strategy].
Karnataka has proposed mandatory HIV test for couples. Another state Andhra Pradesh favoured mandatory HIV test before marriage. Goa too proposed the testing ‘by law’ in April 2006. But will this mandatory test alone check new HIV infections? Public health experts disagree. "We need to create an awareness about HIV, and the stigma associated with HIV, especially the stigma within healthcare which keeps people away from accessing these services (which often help to extend one’s life and contribute towards prevention of the disease), strengthen primary healthcare services and enhance sensitivity to issues of confidentiality and the dignity of life of those living with HIV," said health rights' advocate Jashodhara Dasgupta of Sahayog.
We have not been thinking of prevention/treatment in its entirety. States are seen to be promoting HIV prevention strategies completely ignoring the treatment, care and support provisions for people living with HIV.
Andhra Pradesh Chief Minister Y S Rajasekhar Reddy said last month: "I fail to understand the reasons behind the objections raised by some human rights activists on the government's initiative for making HIV/AIDS tests mandatory for couples before marriage."
What human rights' advocates would like to tell Dr Reddy is that the impact of HIV positive diagnosis on an individual's life is enormous. The combination of stigma, discrimination and denial associated with HIV, thwarts an individual's life in a myriad ways. What are the plans for people who test HIV positive? Will they have to face life without even access to primary healthcare services? In violation of NACO's (National AIDS Control Organisation) confidentiality guidelines, the HIV positive status becomes public knowledge in communities of the would-be bride and groom. Are we prepared to meet the healthcare needs of people who test positive, and ensure that they will not be forced to lead a life adversely hit by HIV-associated stigmas, discrimination and denial?
A United Nation's Programme official has said that Karnataka should think about the issue again as mandatory HIV testing will prove to be counter-productive. It not only violates privacy but also affects the entire family with a stigma tag, and 'tends to create a blackmarket in false HIV test results'.
Senior Advocate Colin Gonzalves said that "any mandatory testing is wrong. Couples should rather be counselled and educated. If they want to get a testing done by choice after that, it's their business. But a mandatory test can't be imposed on them".
NACO guidelines say that "testing for HIV is more than merely biological for it involves ethical, human and legal dimensions. The government feels that there is no public health rationale for mandatory testing of a person for HIV/AIDS. On the other hand, such an approach can be counter productive as it may scare a large number of suspected cases from being detected." The HIV test alone will not result in behavioural changes. It should be a part of a comprehensive control programme which helps in the individual’s behaviour.
Providing social support, means and skills to reduce or eliminate risk behaviour. NACO official further adds that "Otherwise such testing can drive the target people underground and make it more difficult for launching intervention." As access to antiretroviral treatment is scaled up, there is a critical opportunity to simultaneously expand access to HIV prevention, which continues to be the mainstay of the response to the HIV epidemic. Without effective HIV prevention, there will be an ever increasing number of people who will require HIV treatment. Among the interventions which play a pivotal role both in treatment and in prevention, HIV testing and counselling stands out as paramount. The current reach of HIV testing services remains poor. The reality is that stigma and discrimination continue to stop people from having an HIV test. To address this, the cornerstones of HIV testing scale-up must include improved protection from stigma and discrimination especially within healthcare settings, as well as assured access to integrated prevention, treatment and care services. Just earlier this month, a pregnant woman with HIV died after being denied medical attention in Indore . Undoubtedly public health strategies and human rights promotion are mutually reinforcing. It is clear that India has a long way to go before we have a public health system strong enough to deliver effective healthcare to most underserved communities. And mandatory HIV testing alone is certainly not the short-cut.
(The author is a senior health and development journalist writing for newspapers in Asia, Middle East and Africa
Bangalore, Karnataka
3 May 2007
HIV TEST
The bigger picture
By Bobby Ramakant
[The test must be part of a comprehensive rehabilitation strategy].
Karnataka has proposed mandatory HIV test for couples. Another state Andhra Pradesh favoured mandatory HIV test before marriage. Goa too proposed the testing ‘by law’ in April 2006. But will this mandatory test alone check new HIV infections? Public health experts disagree. "We need to create an awareness about HIV, and the stigma associated with HIV, especially the stigma within healthcare which keeps people away from accessing these services (which often help to extend one’s life and contribute towards prevention of the disease), strengthen primary healthcare services and enhance sensitivity to issues of confidentiality and the dignity of life of those living with HIV," said health rights' advocate Jashodhara Dasgupta of Sahayog.
We have not been thinking of prevention/treatment in its entirety. States are seen to be promoting HIV prevention strategies completely ignoring the treatment, care and support provisions for people living with HIV.
Andhra Pradesh Chief Minister Y S Rajasekhar Reddy said last month: "I fail to understand the reasons behind the objections raised by some human rights activists on the government's initiative for making HIV/AIDS tests mandatory for couples before marriage."
What human rights' advocates would like to tell Dr Reddy is that the impact of HIV positive diagnosis on an individual's life is enormous. The combination of stigma, discrimination and denial associated with HIV, thwarts an individual's life in a myriad ways. What are the plans for people who test HIV positive? Will they have to face life without even access to primary healthcare services? In violation of NACO's (National AIDS Control Organisation) confidentiality guidelines, the HIV positive status becomes public knowledge in communities of the would-be bride and groom. Are we prepared to meet the healthcare needs of people who test positive, and ensure that they will not be forced to lead a life adversely hit by HIV-associated stigmas, discrimination and denial?
A United Nation's Programme official has said that Karnataka should think about the issue again as mandatory HIV testing will prove to be counter-productive. It not only violates privacy but also affects the entire family with a stigma tag, and 'tends to create a blackmarket in false HIV test results'.
Senior Advocate Colin Gonzalves said that "any mandatory testing is wrong. Couples should rather be counselled and educated. If they want to get a testing done by choice after that, it's their business. But a mandatory test can't be imposed on them".
NACO guidelines say that "testing for HIV is more than merely biological for it involves ethical, human and legal dimensions. The government feels that there is no public health rationale for mandatory testing of a person for HIV/AIDS. On the other hand, such an approach can be counter productive as it may scare a large number of suspected cases from being detected." The HIV test alone will not result in behavioural changes. It should be a part of a comprehensive control programme which helps in the individual’s behaviour.
Providing social support, means and skills to reduce or eliminate risk behaviour. NACO official further adds that "Otherwise such testing can drive the target people underground and make it more difficult for launching intervention." As access to antiretroviral treatment is scaled up, there is a critical opportunity to simultaneously expand access to HIV prevention, which continues to be the mainstay of the response to the HIV epidemic. Without effective HIV prevention, there will be an ever increasing number of people who will require HIV treatment. Among the interventions which play a pivotal role both in treatment and in prevention, HIV testing and counselling stands out as paramount. The current reach of HIV testing services remains poor. The reality is that stigma and discrimination continue to stop people from having an HIV test. To address this, the cornerstones of HIV testing scale-up must include improved protection from stigma and discrimination especially within healthcare settings, as well as assured access to integrated prevention, treatment and care services. Just earlier this month, a pregnant woman with HIV died after being denied medical attention in Indore . Undoubtedly public health strategies and human rights promotion are mutually reinforcing. It is clear that India has a long way to go before we have a public health system strong enough to deliver effective healthcare to most underserved communities. And mandatory HIV testing alone is certainly not the short-cut.
(The author is a senior health and development journalist writing for newspapers in Asia, Middle East and Africa
online available at - http://www.deccanherald.com/deccanherald/may32007/panorama21333200752.asp
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