Monday, January 18, 2010

Compulsory HIV Testing for Pregnant Women is Counterproductive

It's probably a good thing that Uganda has merged the provision of sexual and reproductive health with HIV programmes. It remains to be seen whether they do a good job of it and the fact that both functions will still be provided by two different government departments doesn't bode well.

But the proposed introduction of mandatory HIV testing for pregnant women is worrying. Most countries in the world have considered mandatory testing at some time and many have resisted it. The WHO has opposed it and, as far as I know, continues to oppose it. Not only is it considered to be a human rights abuse, but it is also thought to be counterproductive.

If it is a human rights abuse to carry out mandatory testing for specific groups for any disease, then it is an abuse to single out pregnant women for HIV testing. One of the dangers is that fewer women will attend ante natal clinics, with potentially disastrous consequences. But at present, Uganda is not providing ante natal care for all pregnant women. Will they start to provide it? Where will they get the money? And will ante natal care become mandatory too?

All people have the right to medical care, to treatment for illnesses, prevention of diseases, general health, reproductive and sexual health, etc. But what Uganda is proposing is that it will no longer be a woman's right to choose to be tested for HIV if she is pregnant, nor will it be her right to choose whether to be treated or not, nor will it even be her right to keep her HIV status confidential.

Ugandan health and social services are not able to cope with current levels of HIV, they have had constant problems testing people, treating people and maintaining supplies of medication. The country's health services function poorly and wouldn't function at all if it wasn't for high levels of donor support. But someone has now decided to make it even less likely that a large and vulnerable section of the population will seek health care just when they are most vulnerable. It is not just the pregnant women who are put in danger by such a proposal, it is also their unborn babies, perhaps their children, their partners and others.

The Ugandan government is not able to guarantee the safety of women who have been diagnosed as HIV positive. It is not able to guarantee that they will not be rejected or even persecuted by family and neighbours. It is not even able to guarantee that women will get adequate care to live a healthy life and raise their children to be healthy and strong.

HIV testing needs to remain an option to all people, including pregnant women. It needs to remain something people freely choose, something to which they can give their informed consent. That means they need to be counseled and advised before testing and supported after testing. This is the only way to ensure that the maximum number of people will agree to be tested for HIV. It is also the only way to support people in continuing to live a healthy and peaceful life in their own community and to take every step to avoid infecting others.

Compulsory HIV testing will not stop HIV from spreading. It will only make people fear testing, especially those most likely to be infected. Compulsion will result in the very people who most need to be tested avoiding testing centres and any place else where they may have to face a test, such as ante natal clinics and hospitals. Then, by the time people infected with HIV are identified, they may already be at an advanced stage of the disease and may well have infected many others.

The Ugandan government needs to encourage women to attend ante natal clinics when they are pregnant, not compel them to do so. People, whether pregnant or not, need to be advised to know their status, with regard to HIV and any other transmissible disease. If there is any chance of influencing people's sexual and reproductive behaviour, it is more likely to be achieved through education and support. It will certainly not be achieved through coercion, as Uganda and other countries have already spent nearly three decades finding out.



Dan said...

Ya, That test must compulsory because it can save the child from infecting of HIV if the mother is HIV positive.

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Simon said...

Perhaps you should read the article or even the title before commenting. Making a test compulsory doesn't guarantee that a child will be born HIV negative because making the test compulsory often has the effect of putting people off attending clinics, therefore the unborn child could be in more danger. Providing the test once informed consent has been given usually ensures that the mother is in a position to receive prevention of mother to child treatment, if the country is in a position to provide it. Uganda is in a position to provide this treatment to some, and only some, pregnant women.