Is mandatory HIV testing for all what South Africa needs to fight the epidemic? Statistics show that there are about 1 500 new HIV infections a day.
The call for mandatory testing, which is now finding greater space in the public discourse, took me back a few years, when a close friend died of Aids. He died despite having the best information on treatment and support. In the two months before his death, he was in and out of hospital, but he did not test for HIV until his CD4 count reached 5. When he got his result, he refused to accept it, and accused the hospital of giving him the results of another patient. A few weeks later, he died.
A great many people infected with HIV die without receiving any medical help or even knowing their status. The call for mandatory testing comes as a sense of frustration seems to be setting in about why more people are not coming forward to learn their status.
When I tested for HIV in 1999, my doctor initiated the process. At the time, I didn’t think I needed it, but agreed to the test because my doctor gave me medical reasons for why I should have it. I tested HIV-positive, and I do not regret my decision. I know my status and that has helped me to look after myself.
But I would have had a problem if my doctor had made me undergo the test before I was ready.
Fortunately, the government does not appear to support the call for mandatory testing. Instead, it looks set to adopt a more cautious but prudent approach called ”provider-initiated HIV testing and counselling”. This, in essence, is what led to my HIV test: my doctor argued for it; it wasn’t regulated by the state.
The World Health Organisation’s recommendation for a country like South Africa, where the epidemic is generalised, is clear: ”Where an en-abling environment is in place and adequate resources are available, including a recommended package of HIV prevention, treatment and care, health care providers should recommend HIV testing and counselling to all adults and adolescents seen in all health facilities.”
The government’s national strategic plan endorses this approach. I believe it gives patients the auto-nomy to decide what they want to do. And it could work well if South Africa’s health infrastructure is brought up to date, with enough resources and an ”enabling environment”. The gaps in public health care are evident, and the government’s plan will strain at the seams.
With such high HIV prevalence, South Africa should be testing every-one who needs to be tested. Voluntary counselling and testing centres should continue to serve those areas where public health facilities are not available. But voluntary counselling and testing alone are not effective. We need more creative ways to get people to test.
Perhaps the government should offer public health users incentives to take HIV tests — such as a food grant when they get sick, especially those who need social assistance. Everyone needs to think imaginatively, and creative measures like this might just be part of the solution.
But it is alarming that those who want mandatory HIV testing don’t seem to consider the possibility that people’s rights may be violated in the process.
In many ways, stigma and discrimination are driving this epidemic, and we cannot pretend otherwise. I would personally support the suggestion to test people as part of a general health check-up — but only because I have knowledge about HIV and awareness of my rights. But there are tens if not hundreds of thousands of people who could be harmed by this proposal.
Mandatory testing would only drive people into hiding, instead of bringing them to the front of the queue. This is no solution.
Pholokgolo Ramothwala is a field researcher at the Aids Law Project