Should HIV Testing Be Mandated For All In India?
Diagnosis of human immunodeficiency virus (HIV) is a major impediment in the way of eradication of the disease. In spite of several campaigns and awareness drives the number of people living with HIV in India is substantial.
Although African countries dominate the list of top 10 nations with highest AIDS rates in the world, India ranks third, after South Africa and Nigeria. Currently, there are about 2.1 million HIV infected people in India. Experts say, early diagnosis can lead to early treatment and prevention of transmission of acquired immune deficiency syndrome (AIDS).
Know AIDS for No AIDS
According to a new World Health Organisation (WHO) progress report, lack of an HIV diagnosis is a major obstacle to implementing the Organization’s recommendation that everyone with HIV should be offered antiretroviral therapy (ART).
The report reveals that more than 18 million people with HIV are currently taking ART, and a similar number is still unable to access treatment, the majority of which are unaware of their HIV positive status. Today, 40% of all people with HIV (over 14 million) remain unaware of their status. Many of these are people at higher risk of HIV infection who often find it difficult to access existing testing services.
“Millions of people with HIV/AIDS are still missing out on life-saving treatment, which can also prevent HIV transmission to others,” said Dr Margaret Chan, WHO Director-General.
Given this scenario, it is important to think if HIV testing should be made mandatory for everyone. While we have treatment, prevention and eradication of the disease on one side, we have factors like infringement of individual’s privacy and social stigma on the other side.
“Testing a patient of HIV when he/she starts showing clear symptoms, it is too late for treatment. If a patient is diagnosed early, treatment can start early leading to further prevention of its transmission,” said Dr Prakash Bora, Founder Director, HIV-AIDS Care and Research Foundation.
Indian society doesn’t treat HIV/AIDS patients as any other patient. The social stigma attached to the disease leads to many further issues and thus confidentially is usually maintained with relation to HIV status of a person.
Bora however believes that this confidentiality further aggravates the problem. “It is due to this confidentiality that diagnosis of the disease takes time leading to its further spread. If HIV testing is mandated for everyone, people will accept it as a normal part of any treatment and not look at it with suspicious eyes. The social stigma is going down with changing times but this could further lead to eradication of the stigma.”
It is not just the physical trauma that HIV/AIDS patients undergo; the psychological trauma takes a toll too. “Recently, a friend of mine was detected as HIV positive. Realising this, she went to a secluded place and slit her own throat. The stigma around the disease killed her,” said Urmi Jadhav, a transgender activist who also works for various HIV outreach programmes.
“We insist people to get themselves tested for HIV but cannot have it mandated because our society leads to ‘self stigma’. It is the stigma and panic that patients imbibe in them fearing about what others will think about him/her. Patients taking treatment also hide their status from their family and friends. Many housewives wrap their medicines and hide them in places like rice containers,” added Jadhav.
Based in Pune, Dr RR Gangakhedkar from National AIDS Research Institute also believes that HIV testing should not be mandated for all. His reasons seem to be more from practical views.
“It doesn’t make sense to test everyone for HIV. Currently, there is a big dilemma as to what should be paid more attention – treatment or prevention. We need to set our priorities right and test people who have symptoms of HIV/AIDS or its associated diseases like tuberculosis, chronic diarrhea among others or people prone to contracting the disease like sex workers or men who have sex with men (MSM),” said Gangakhedkar.
He further explained, “Government faces fund crunch for existing treatments. Having compulsory testing will add to the cost of government in public hospitals. So designing a way where people prone to the disease are not left out and money is not spent on testing for people who have high chances of not contracting the disease would yield good results in the long run.”
It was in 1984 that the virus was detected and World AIDS Days is being observed since 1988. In all these years various awareness drives have been taken up at local, national and international levels. This World AIDS Days, the Red Ribbon Project marks 25th year generating consciousness and compassion among people who have tested positive for HIV and their loved ones. But Indian society is yet to embrace HIV/AIDS victims without disgrace and fear.
“Unfortunately, in the society we live in, HIV test report tends to tell about the character of a person. We fail to understand other reasons of transmission of the virus apart from sexual relationship,” Dr IS Gilada, President, AIDS Society of India.
Match your health reports before wedding just the way you match your kundlis
According to Gilada, HIV testing should be a part of the overall health check up before any major decision of one’s life like getting married, conceiving a child, getting operated among others. “An overall health check-up should be done before the wedding with various tests including diabetes, hypertension, TB, HIV and hepatitis among others. It is about health awareness and nothing about any stigma. A well designed system with maintained privacy and necessary health measures should be devised. It should be ensured that the tests are not the base of employment or any such other opportunities.”
Many countries have mandated HIV testing and successful in bringing the numbers down. Social stigma and economic crisis play a hurdle in the way to this accomplishment in India.
For a holistic solution to put an end to the syndrome, Bora suggests we do not discriminate between diseases. He advised, “If we want to eradicate HIV/AIDS like any other major disease, we need to treat it and work on it like any other disease too; without any stigma.”
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Regards,
The CSR Journal Team
