Mandatory testing for HIV

Stabroek News
February 15, 2000

Minister of Health, Dr Henry Jeffrey, announced last month that the Ministry of Health was moving to implement mandatory HIV testing of all pregnant women as a means of trying to reduce the risk of their babies being born with the virus.

This initiative, the minister said, would prevent mother to child transmission of HIV. He added that resources were available to ensure the implementation of this programme. The minister's speech did not hint at the obvious legal, human rights, economic and ethical issues which must be considered, before such a move could even be contemplated.

Has the ministry conducted a study to determine how many pregnant women are testing HIV positive and whether there is need for such a programme at this time?

Is there to be a pilot of this programme or is the ministry jumping in with both feet? Is the ministry training nurses at public health clinics, who pregnant women interface with to provide counselling to the women who are to be tested? And since HIV is also transmitted through breast milk, will the ministry procure milk supplements for all the babies whose mothers test HIV positive and cannot afford to purchase same?

If women, in their refusal to be tested, stop attending ante-natal clinics, would this not be a retrograde step for the entire maternal/child health programme? Can not the Ministry of Health better serve women, and the entire population, by empowering them to negotiate for safer sex? That way there would be no HIV for them to transmit to their babies.

What the minister also did not mention in his speech, but is available in published literature, is that after testing positive--and the test must be done early in the pregnancy--the woman has to be treated with antiretroviral drugs, which are not readily available to other HIV positive Guyanese. The Ministry of Health would have to obtain these very expensive drugs for free distribution to pregnant women. This would mean that the drugs would be given on a short-term basis and most likely would not be available to the woman after her baby is born. The result? More orphans and no corresponding increase in infrastructure to deal with this.

And what of the men? Is there any corresponding programme to deal with the partners of pregnant HIV positive women? If they have not already been tested, will the prenatal clinics cater for them also? A draft AIDS Prevention and Control Bill currently in circulation, states, under the heading Rights and Duties: "No person shall compel or require another to undergo an HIV test for the purposes of employment, insurance, medical coverage, the provision of goods and services or for any other purpose...." Words to this effect also appear in the Policy Document on HIV/AIDS in Guyana, which goes further to state that any mentally competent adult who has tested HIV positive, has the right to refuse diagnostic or therapeutic procedures recommended by health personnel. Are pregnant women to be excluded from this clause?

The Joint United Nations Programme on HIV/AIDS (UNAIDS), in a booklet titled 'Prevention of HIV Transmission from Mother to Child, Strategic Options', states: " ...It is the pregnant woman's absolute right to choose, on the basis of full information, whether or not to take advantage of the intervention. Coercion is not justified under any circumstances, even if it seems to be in the best interests of the woman or her child, and her choice should always be accepted and respected."

It is clear that a woman's rights cannot be trampled upon in this respect even if the good intention in doing so is to save the life of her child.