ST Forum: Compulsory HIV testing won't stop Aids' spread (Aug 11)

Saturday, August 11, 2007

Aug 11, 2007


Compulsory HIV testing won't stop Aids' spread

I WRITE in relation to the recent proposal for mandatory HIV testing of patients admitted to hospital.

The spread of HIV/Aids is a grave problem which needs to be addressed with effective measures. Unfortunately, this proposal is not one of them.

There are several ways in which we might imagine it would work, but none of them would translate into the desired results.

First, there is the claim that knowledge of a patient's HIV status will protect health workers. However, health workers need to take the same precautions regardless of what the results of the HIV tests are. There are any number of blood-borne pathogens that could be transmitted other than HIV - for example, the organisms that cause hepatitis.

Moreover, there is typically a three-month interval between infection and turning seropositive (i.e., developing the antibodies that are what the test detects), so a person who is HIV negative according to the test could very well still be HIV positive. Therefore, the test results do not help to guide health workers to behave more safely - they must behave safely regardless of the results.

Second, would knowledge of one's HIV-positive status result in changes in behaviour? Unfortunately, this is vastly less likely to be the case with mandatory than with voluntary testing. It is for this reason that no less a body than the World Health Organisation, in its 2004 policy statement, opposed mandatory HIV testing on public-health grounds.

Third, could we somehow compel people who are HIV positive to behave more safely? This is difficult territory as there are obvious privacy and liberty concerns. Given that much risky sexual behaviour or drug abuse is anonymous, compulsive and conducted in intensely private settings, it is difficult to see how this can be achieved.

Fourth, would medical treatments be available to make transmission by a HIV-positive person less likely? Although some anti-retro viral treatments may suppress infectiousness, allowing, for instance, HIV-positive mothers to give birth to HIV-negative children, these treatments are not readily available in Singapore as they are classified as 'non-standard drugs' and remain very expensive.

Whatever the theoretical possibility of this treatment in reducing infectiousness once we know the HIV status of someone, in practice very few will enjoy such benefits.

Even if we were to put aside the substantial ethical compunction that must accompany such an intrusion on privacy, this measure will not be effective in halting the spread of Aids.

Jolene Tan Siyu (Ms)
London, United Kingdom