Counselling before an HIV test discourages people from testing and is a barrier to AIDS treatment, according to one of the country’€™s leading AIDS activists.

In a provocative address to University of KwaZulu-Natal (UKZN) students yesterday (Thurs 4 May), Judge Edwin Cameron said that extensive pre-test counselling had been appropriate in an era where there was no treatment for AIDS and HIV positive people faced little but discrimination.

‘€œBut we now have a mass epidemic where mass treatment is also possible, so extensive pre-test counselling may be a luxury we can no longer afford if we are to reach everyone who needs treatment,’€ said Cameron.

Health workers should be able to routinely test patients for HIV in places where AIDS treatment was available, there was no discrimination and patients’€™ HIV status was kept confidential, said Cameron.

‘€œWhen a person is suspected of having breast cancer, their doctor does not have to counsel them extensively before testing them for cancer,’€ said Cameron.

Before AIDS treatment had become widely available, human rights activists had ‘€œexceptionalised AIDS’€, he said. Extensive counselling was one of the protective measures ‘€œdesigned in a world where an HIV diagnosis meant discrimination’€.

‘€œThe challenge we now face is to normalise AIDS treatment,’€ said Cameron. ‘€œWhere treatment is available, exceptionalising AIDS impedes treatment. There is no reason why AIDS should be treated differently from breast cancer or any other disease.’€

In Botswana, where antiretroviral treatment has been freely available since 2003, HIV tests without counselling are routine at clinics and hospitals unless a patient refuses to have a test.

Cameron was speaking at a memorial meeting for UKZN law lecturer Ronald Louw, who died almost a year ago of AIDS.

Describing Louw as an ‘€œeloquent, informed, AIDS-literate man’€, Cameron said he believed Louw was too afraid to take an HIV test until it was too late because of a sense of ‘€œinner shame’€.

Louw was diagnosed with HIV when he was admitted to hospital less than a month before his death. This was despite the fact that friends concerned about his health had asked him to go for an HIV test some two years before his death.

‘€œRonald died of a paralysing dread of confronting HIV. He was unable to take constructive action to seek life-saving treatment because he lacked internal self-acceptance,’€ said Cameron.

Cameron added that he had also visited St Mary’€™s Hospital outside Durban, yesterday. Despite the fact that the hospital had a renowned AIDS clinic, staff were dying of AIDS because they were too afraid to get tested, he said.

‘€œInternal self-acceptance [of AIDS] has nothing to do with educational levels or sophistication. It is an emotional, human thing. Pre-test counselling may feed into the internal stigma and mean that people who need treatment refuse to be tested.’€ ‘€“ Health-e News Service.