KHOPOTSO: In South Africa, the Department of Health has concerns about making HIV testing a routine practice. The concerns are two-fold. Here’€™s the first.

Dr NOMONDE XUNDU: We’€™re operating within the parameters of the Bill of Rights of the Constitution, whereby we’€™re saying: ‘€˜Yes, it’€™s important for us to diagnose people who are HIV-infected. But in so doing, we shouldn’€™t violate human rights. People should themselves, in fact, agree to that kind of test.’€™

KHOPOTSO: In Botswana, the US and Zambia, the belief is that making the HIV test a fully-integrated component within the health services, alongside the others, helps reduce the stigma associated with the infection. South Africa begs to differ, making it concern number 2.

Dr NOMONDE XUNDU: Would you begin to address stigma at a health facility whereby people would go back to communities and be faced with the same stigma that you’€™re saying you’€™re addressing at the clinic by integrating services? There is a risk of doing that and we’€™ve had cases of people who have been exposed to discrimination because they disclosed after being diagnosed at the clinic. Or, would you educate communities about the importance of getting to know their status early, and also, educating them as to how to live positive, healthy, longer lives supporting one another in society as a whole?

KHOPOTSO: Dr Nomonde Xundu, Chief Director of the HIV and AIDS, TB and STI’€™s Directorate in the national Department of Health. Jonathan Berger of the AIDS Law Project doesn’€™t believe that offering the HIV test as a routine service would go in conflict with human rights’€™ principles.              

JONATHAN BERGER: The routine offer of HIV testing should be introduced in South Africa as long as it is not introduced in a way that dispenses with the need for pre and post-counselling and proper informed consent. It not only makes good public health sense. It’€™s also a Constitutional requirement.

There are ways of respecting people’€™s human rights and giving effect to them in a way which makes good public health sense. I have not yet heard any convincing argument, which explains why violating someone’€™s right to privacy or confidentiality makes good public health sense. The arguments are often made along the line that pre-supposes that the right to privacy, the right to confidentiality, precludes a doctor or another health care worker, from offering testing. And that, in my view, is an incorrect understanding of the right. I think one of the crucial points is that there is no disconnect between good public health and human rights. The two support each other and feed into each other.

KHOPOTSO: Supreme Court of Appeal Judge, Mr Justice Edwin Cameron ‘€“ an activist and a person who lives openly with HIV ‘€“ welcomes the idea of making the HIV test a matter of routine practice. However, he believes that certain ground rules need to be enforced.

EDWIN CAMERON: We’€™ve got to have an environment where treatment is being offered as a real option to the patient; we’€™ve got to have an environment where confidentiality is respected. Confidentiality is different from disclosure. Disclosure is the choice of the patient. And we’€™ve got to have an environment where our legal and Constitutional guarantees of non-discrimination, which the Constitutional Court so boldly reinforced in the Hoffman vs SAA decision, where those are realities that people feel safe-guard them in their lives. Once we have those three pre-conditions I’€™ve mentioned, then we can move to a position where HIV testing becomes routine.

KHOPOTSO: There is agreement that principles that guarantee the respect of the individual need to guide the policy of routine testing, if it were to be introduced to general public. But, it would seem that while it may not be the rule to have routine testing, exceptions can be made. Here’€™s the Department of Health’€™s Dr Nomonde Xundu again.

Dr NOMONDE XUNDU: Where we would routinely offer the test, is mainly for people who have been diagnosed with a sexually transmitted infection, which indicates that these people are sexually active and, therefore, there’€™s a chance that they have been exposed to HIV as well. We offer it to high-risk groups. I’€™m referring to commercial sex workers. I’€™m referring to the unfortunate situation of migrant workers. I’€™m referring to substance abusers. I’€™m referring to long-distance truck-drivers’€¦ We offer it also to prisoners; and also military personnel because they are away from home’€¦

There’€™s a strategy that is called targeted interventions. It’€™s a public health approach whereby you say, ‘€˜let us target this group, specifically because we know that they’€™re the ones at risk and they are in contact with many other people. They are the so-called core transmitters. Let’€™s target them, find out about their HIV status, and assist them to live positively, including your safer sex and looking after themselves, and so on, than offering the service widely in the population and not doing it well. Refine the service whilst you are targeting this critical proportion of the population. And once you get to understand better, and you’€™ve dealt with issues of stigma outside of the health services themselves, then you could say ‘€˜now we’€™re ready to go full-scale in terms of full integration.’€™  

e-mail: Khopotso Bodibe