Zambia: A Quagmire over AIDS testing

Lusaka - Voluntary testing or mandatory testing? That is the question AIDS activists and government officials are grappling with in Zambia, where about one million people have already died in the pandemic since the late 1980s.

The Joint United Nations Programme on HIV/AIDS puts adult HIV prevalence in Zambia at about 19 percent. The country has a population of about 10 million.

As a draft national AIDS policy is still under discussion, lawmakers have yet to finalise their position on the matter of testing.

However, the National AIDS Council, which co-ordinates the activities of all organisations working to combat HIV, has announced plans to place at least 100,000 people on anti-retroviral therapy by 2005 – and called for mandatory AIDS testing in hospitals and clinics to form part of the programme.

This provoked a storm of protest from activists and people living with HIV and AIDS, who claim that compulsory testing is an abuse of human rights – flying "in the face of civil liberties".

Kunima Banda from the Network of People Living with HIV and AIDS says mandatory testing would cause people to avoid going to hospitals when in need of treatment.

Instead, "The way to go would be to scale up VCT (voluntary counseling and testing) so that it is always voluntary, and people will be properly prepared for their results," she adds.

A former health minister, Nkandu Luo, has added her voice to the chorus of discontent.

She notes that more work needs to be done to ensure Zambia’s health facilities are fully capable of dealing with the AIDS pandemic – and that introducing mandatory testing before this has been achieved would be impractical.

Luo, who has just conducted nation-wide research on the availability of VCT sites in the country, says testing and counseling services at many clinics are not up to scratch. In addition, some facilities have insufficient ARVs and suffer from inadequate training of medical personnel in dispensing drugs.

While people in outlying areas may want to get tested for HIV, the facilities that could enable them to do so are often located too far from their communities. Those who succeed in visiting a clinic may find that testing kits have run out – and that information on how to access anti-retroviral drugs (ARVs) is sketchy.

In fact, Luo says, the general lack of information about the pandemic means that many people still think of HIV and AIDS in terms of witchcraft: "In this scenario, how can government want HIV screening to be mandatory? (We need to put) first things first: information and prioritization of resources, so that systems and facilities are in place (with) support for people on ARVs, (like) good diet and counseling."

Maybin Kumwenda who tested HIV-positive in 2000, says part of him still wishes that he did not know his status, as this knowledge has brought him a lot of sympathy – but little in the way of tangible benefits.

Like many Zambians, Kumwenda is poor and cannot afford ARVs, even those subsidized by government. Although he should be keeping his health up by having three square meals a day, this isn’t always possible.

"I see many people in my shoes...I do not think mandatory testing is the way to go in the absence of a strong social support system," Kumwenda notes.

But health officials view things differently.

A doctor, Gregory Manda, says the initial burst of enthusiasm created by the opening of VCT centres has died down – and that there is now a slow trickle of people wanting to be voluntarily screened for HIV.

He adds that sensitivities around HIV testing have also created the bizarre situation where medical staff who suspect that a patient may be HIV-positive nonetheless test for a variety of other ailments first – a process of elimination that is expensive and time-consuming.

"Because of this human rights and liberties fear that surrounds HIV we leave HIV testing as a last resort when it should be first, and the patient should be told and counseled on admission. That way, the patient is treated quickly and there is a minimum wastage of resources on unnecessary tests," says Manda.

He notes that a more direct and unembarrassed approach would also be to the advantage of medical personnel – whose behaviour is affected by attitudes towards HIV and AIDS.

"Can you imagine if a patient who has been in the hospital for some time, suddenly finds medics treating him with extreme caution because they have just discovered his HIV status?...It is happening now in our institutions; people do not need to be told their status – it shows in the different way they are treated once tested."

Nurse Suzgyo Mukande also believes that, while voluntary testing would be the best option, government needs to take an unpopular position on this matter for the general good.

"We have a VCT centre in the hospital grounds but few people make use of it – only those who are very sick and have been coerced into testing," she says.

Mukande believes that if every single person who visited a health centre was informed of their HIV status, there would be a reduction in the cost of diagnosing and treating illnesses.

This would free up funds to provide additional resources for the health and safety of medical personnel, she adds. At present, items like disposable gloves, needles and protective sheeting and disinfectants are always in short supply.

"If HIV testing is mandatory, government would in turn be obliged to scale up services in health institutions. It would also mean a refocus on the entire health sector with more resources both in personnel and funds," says Mukande.

Decision-makers in other spheres have gone ahead with mandatory testing, even though this flies in the face of the ‘Southern African Development Community Code of Conduct on HIV/AIDS and Employment’ – which explicitly forbids compulsory AIDS tests in the workplace.

The Konkola Copper Mines conglomerate, for example, has stated that its miners will be screened for HIV to enable the company to formulate a comprehensive health policy for employees. Zambia’s Ministry of Defence has also decreed mandatory testing for new recruits.

Current minister of health and retired soldier Brian Chituwo has since been put in the awkward position of agreeing that mandatory testing does clash with civil liberties – while defending government’s decision to screen its troops.

Manda says that Chituwo’s statements speak volumes about the confusion on this topic: "There is no consensus in government.”
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