A testing question
Living with AIDS # 282
KHOPOTSO: In a population exceeding 40 million not even close to one million get tested for HIV annually in South Africa. But 5.5 million people are estimated to be living with HIV and many don’t know their HIV status or just simply do not consider themselves vulnerable to infection. By March last year, only 850 000 South Africans had been tested for HIV in the past four years. In neighbouring Botswana, a similar pattern of poor utilisation of Voluntary Counselling and Testing Services was experienced. To get more people to use testing services, President Festus Mogae issued out a decree in January 2004 making HIV testing a routine service in public health facilities. Dr Patson Mazonde is the Director of Health Services, in Botswana.
Dr PATSON MAZONDE: We have the prevention of mother-to-child transmission programme. We have antiretroviral therapy. Now, in order for patients to be able to access these services they need to know their status. And secondly, of course, it is important that if we must be able to prevent further infections people should know their HIV status. It is for this reason that we thought that we needed to introduce the issue of routine testing.
KHOPOTSO: Dr Ernest Darkoh, former Operations Director of Botswana’s National Antiretroviral Programme, explains how the system works.
Dr ERNEST DARKOH: The only testing that used to exist was voluntary opt-in. Now, we’re saying routine opt-out. The difference between the two is the fact that now what we’re telling people is that ‘if you come in with any sign or condition that is suspect of HIV, you are offered the test as a matter of routine’. So, across the board everybody who comes in to the hospital is basically offered the test and told ‘we’re going to do the following tests on you’¦ one of which may be the HIV test’. Now it would be for the patient to say ‘doctor, I don’t want the HIV test’. So, they can opt-out. And they’ve been informed of their right to opt-out of the test.
KHOPOTSO: Botswana has a population of 1.7 million and a 37.4% prevalence rate of HIV.
Dr ERNEST DARKOH: What we’ve found is (that) very, very few people opt-out. Less than 5% of people opt-out. So, essentially right now the success of our testing has jumped to 95% basically’¦ as opposed to before where it was less than 20%.
KHOPOTSO: South African Supreme Court of Appeal Judge, Mr Justice Edwin Cameron, is one of a small but growing list of influential people calling for South Africa to follow Botswana’s lead and make HIV testing a routine procedure.
EDWIN CAMERON: We have got to make HIV testing a routine, ordinary, normal part of any medical treatment ‘ in hospitals, in clinics, in any visit to any doctor or healthcare worker. We’ve got to de-stigmatise HIV testing. At the moment the special walls that we build around HIV testing make it more difficult for people to access HIV testing. We are making it more difficult for people to know their HIV status and, therefore, we are making it more difficult for them to get access to treatment. So, the present inhibitions – the present restrictions – on testing are actually costing lives.
KHOPOTSO: Cameron’s colleagues in the legal fraternity disagree. Mark Heywood is with the AIDS Law Project.
MARK HEYWOOD: I disagree with the position in Botswana because what happens in Botswana is that a person goes into a hospital and they’re told ‘we are going to test you for HIV unless you tell us not to test you for HIV’. And that is not a good health intervention. And what we see in Botswana is that even though that policy has increased the numbers of people who know their HIV status, there’s still a lot of stigma and misunderstanding’¦ Ironically, in Botswana we have the opposite of South Africa where the government is trying to mobilise against HIV, but society remains immobilised. In South Africa, we have a society largely mobilised against HIV, but government immobilised.
KHOPOTSO: The new National AIDS Council, chaired by Deputy President Phumzile Mlambo-Ngcuka, is taking shape. The country’s HIV/AIDS strategy for 2007-2011 is to be launched on World AIDS Day 2006. One of the pressing questions key role-players are asking is: How to persuade many more South Africans to take up testing services?
The debate around whether to introduce routine HIV testing centres around human rights. In the next ‘Living with AIDS’ feature, we’ll look at this issue versus the protection and preservation of health in the era of the AIDS epidemic.
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