Justin Pearce
Signs at Johannesburg General Hospital stating that=20 patients can be routinely tested for HIV are to be=20 removed, says superintendent Dr Robert Odes.
This follows a complaint by an outraged patient who=20 recognised that routine testing was contrary to Health=20 Department policy and World Health Organisation=20 guidelines. The Aids Law Project at the University of=20 the Witwatersrand has also been considering taking the=20 hospital to court to end the policy of routine testing.
The matter was brought to the attention of the Aids Law=20 Project and the Mail & Guardian by Ruth van der Vindt,=20 who took her 22-month-old son Jude van Wyk for a minor=20 hernia operation at the hospital.=20
Van der Vindt was appalled to see a sign in the=20 paediatric section warning: “Aids is a reality. It is=20 therefore the policy of this department to test=20 patients for HIV infection when clinically indicated.=20 If you have any objections to this policy, please=20 inform the doctor in charge.”
The same sign is displayed in several other=20 departments. The orthopaedic surgery department=20 displays a more detailed set of rules, including the=20 provision that “patients who refuse to be tested should=20 be treated as HIV positive”, and that in certain=20 instances a principle of “no test, no operation” should=20
Quarriasha Abdool-Karim, director of the government’s=20 HIV/Aids and Sexually Transmitted Disease Programme,=20 said general screening for HIV is not Health Department=20 policy. “It is not cost-effective or valid to test=20 everyone,” she said.
She said that tests should be conducted only in cases=20 where the result would have an impact on the clinical=20 management of the patient — and then only with the=20 consent of the patient, and pre- and post-test=20 counselling for the patient.
Zackie Achmat of the Aids Law Project expressed the=20 concern that with hospital signs only in English and=20 Afrikaans, patients who cannot read in those languages=20 could find themselves confronted with an HIV test with=20 no prior knowledge of the test or its implications.
Superintendent Odes agreed that the signs were not=20 valid. He confirmed that hospital staff should conduct=20 HIV tests only with the informed consent of the=20 patient, and after considering the case individually=20 rather than as part of a general procedure.
“Aids is far too sensitive and emotional an issue to=20 bandy around on signs.”
Odes was surprised to hear about the sign in the=20 paediatric department, saying that the “no test no=20 operation” principle could not be supported.
Arguments favouring compulsory testing for patients=20 cite the need to protect surgeons from HIV infection –=20 particularly in the case of orthopaedic operations=20 which involve splintered bones and copious blood.
However, Odes said that there were precautions which=20 ought to be taken when operating on any patient=20 regardless of HIV test result — but these precautions=20 are not universally applied.
A new HIV infection is followed by a “window period”=20 during which a patient may test negative but can still=20 pass on the virus. Consequently, a negative test result=20 should not be interpreted as a sign that the surgeon=20 cannot be infected from the patient.