Dr Francois Venter has very little time: his controversial op-ed piece in a Sunday newspaper calling for mandatory HIV/Aids testing for all South Africans has made him much sought-after at the third South African Aids Conference in Durban: people are keen to debate the ethics around the issue.
Venter, president of the South African HIV Clinicians Society and clinical director at the reproductive Health and HIV Research Unit at Wits University, admits that he is deliberately stirring up ‘creative debate” around the issue of testing for HIV/Aids in the country.
‘I don’t necessarily agree with mandatory testing, but I think we have to come up with creative solutions to the problem of people not testing, or testing when it is too late,” says Venter.
Currently, the South African health system operates on a volunteer counselling and testing or client-initiated testing and counselling basis, where tests are conducted if requested by patients.
Venter says tests are being conducted on patients too late into their disease, increasing costs and the burden on the healthcare system, while also increasing the number of lives lost to a disease that can be lived with, especially if detected and treated early.
He is backed by 2005 Human Sciences Research Council surveys, which show that only 2% of South Africans test for HIV every year. The study found that 66% of respondents think they are ‘probably or definitely not at risk for HIV”, while 51% of survey participants who tested positive for HIV ‘thought they would probably or definitely not get infected with HIV”.
But activists and advocacy groups are wary of the human rights infringements and ethical implications of mandatory testing.
‘We recognise the need to scale up HIV/Aids testing and expand access to testing because for a lot of people it is the entry point for treatment,” says Fatima Hassan, a lawyer with the Aids Law Project.
But Hassan warned that mandatory testing could reverse some of the advances made in recent years in the fight against the pandemic in South Africa and could drive the disease ‘underground again”.
Last week the World Health Organisation and UNAids released a guiding document on HIV testing and counselling at health facilities, which ruled out mandatory and coercive testing. Instead, the document called for an ‘up scaling” of testing in areas hardest hit by the disease.
UNAids suggests that HIV-testing be recommended to ‘all patients … whose clinical presentation might result from underlying HIV-infection; as a standard part of medical care for all patients attending health facilities in generalised HIV epidemics; and more selectively in concentrated and low-level epidemics. Individuals must specifically decline the HIV test if they don’t want it performed,” states the document.
Peter Piot, executive director of UNAids, says: ‘[The document] encourages access to testing at every contact with the health system — Mandatory testing is a pure violation of human rights that is not acceptable by international standards. But making sure that the opportunity is there and making use of it — that I think can be used to save lives.