Rights & public health
Living with AIDS # 283

KHOPOTSO: The current model of HIV testing is governed by the principle of choice. Hence, it’€™s called Voluntary Counselling and Testing. Those who argue against the HIV test being offered to patients routinely at every contact with the health service fear that this model would strip people of their right to choose to take the test or not.

 

Dr NOMONDE XUNDU: We’€™re operating within the parameters of the Bill of Rights of the Constitution, whereby we’€™re saying: ‘€œYes, 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: Dr Nomonde Xundu, manager of the HIV and AIDS, TB and STIs cluster in the national Department of Health. But Judge Edwin Cameron of the Supreme Court of Appeal in Bloemfontein, fails to understand how making the HIV test a routine part of health care provision can be in violation of human rights.

 

EDWIN CAMERON: When we talk about human rights, we have to remember that the ultimate in human rights is the respect for the autonomy and the life and the dignity of the person concerned. We are not respecting the autonomy and dignity of people by encouraging them to remain ignorant of their own HIV status’€¦ Why are we keeping HIV exceptional when treatment is available – when we can save lives? We should

de-stigmatise testing; de-stigmatise access to treatment by making HIV testing a routine part of medical and health care treatment.        

 

KHOPOTSO: Mark Heywood – yet another legal mind – works with the AIDS Law Project, in Johannesburg. He concedes that if the HIV test were to be integrated as a routine procedure in health care practice, numbers of people coming forward to test would increase. But he differs on one point: That the model must not dispense with the component of pre and post-test counselling.  

 

MARK HEYWOOD: I argue that counselling is a critical part of the health intervention. But I also argue that counselling is a human right because it ensures that people take autonomous decisions to test and it ensures that people’€™s dignity is protected’€¦ I believe that testing should be offered routinely. I believe that we need a change of policy in South Africa so that the thousands of people in our hospitals and clinics with tuberculosis, with skin infections, with upper respiratory tract infections are offered an HIV test because it’€™s quite likely that HIV may be the cause of that. The only thing is that in making that I say that counselling has to accompany it.          

 

KHOPOTSO: Dr Ruben Sher is one of the first doctors who saw HIV/AIDS in the 1980s. These days he runs a small specialist practice in Auckland Park, Johannesburg.

 

Dr RUBEN SHER: Make a diagnosis and treat’€¦ How much counselling do you need? Do you need to sit for two hours counselling a patient? Haven’€™t we created a monster that’€™s not that important, especially that we have (anti)retroviral drugs? If I have a diabetic here, do I counsel him? He’€™ll be told where to go and what to eat. But what’€™s going to save his life? Insulin. Would you rather have human rights and die or would you have antiretrovirals and live? If they’€™re dying and they’€™ve got a CD4 count of 20 what good is counselling going to do to them? They need antiretrovirals’€¦ Voluntary Counselling and Testing is the way we have been going, but I would rule out the Counselling – Voluntary Testing.

 

KHOPOTSO: Advocates for the introduction of routine HIV Testing argue that it’€™s often too late when people take up Voluntary Counselling and Testing services. They are usually too ill, which makes the anti-AIDS treatment a slow difficult process or it just doesn’€™t help, with death being the inevitable end. This, they argue, is an unacceptable situation – especially when treatment is now available. Steve Ngobeni, national HIV/AIDS

co-ordinator for the South African Human Rights Commission argues that the debate should not simply be about whether or not to test and if the model is in violation of human rights.      

 

STEVE NGOBENI: Even after 25 years or so of having known about HIV and AIDS, a lot of people are still confused about it’€¦ Up to this point HIV and AIDS is an issue that is least understood. We still have a long way to go for people to be able to say ‘€œI have adequate knowledge about HIV and AIDS and these are the choices I can make for myself with regard to HIV’€’€¦ When HIV/AIDS was introduced to this country we were told that AIDS kills. And there is very little that has been done to correct that’€¦ That is why people don’€™t want to know their status because once they know they are positive what comes to their mind is death. Whether we make it mandatory or people go for HIV testing voluntarily this still remains – that HIV brings death’€¦

 

KHOPOTSO: Ngobeni continues.

 

STEVE NGOBENI: I personally feel that it becomes a useless exercise for people to know their status, get to a stage where they need to access treatment and it’€™s not there. And now if people are arguing that we need to make HIV/AIDS mandatory in terms of testing, what are we going to offer thereafter in terms of people accessing treatment? We have, according to government’€™s stats now, over 31 000 people who are actually waiting to access treatment’€¦ It’€™s not there’€¦ The health care system is over-burdened’€¦ There are quite a number of issues that make people not to go for Voluntary HIV (Counselling and) Testing.          

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