Residents in at least three provinces say they have been coerced into undergoing HIV testing at various government health facilities, and that in some of the clinics, an HIV test is a prerequisite for receiving any health services, writes Sisi Segalo for Health-e News.
Patients in the Free State, North West and Gauteng have all said testing is done without counselling before or after, and while many of them are not opposed to actually being tested, they resent not being given more information about the process, as well as counselling, they complained.
Several people Health-e News spoke to at Sandown Clinic in Sandton said they had been tested for HIV – without being asked and with no explanations – while at Hillbrow clinic, a patient said this was common practice.
“They also do a TB test – and even the children are tested for HIV…which is offensive.”
At Yeoville Clinic, one patient said they are advised to get an HIV test if they haven’t already done so. “It’s a must to test for HIV because you cannot be helped if you haven’t done it.”
In the North West Province, patients also claim that they are tested for HIV without consent, and that for mothers with babies, it is a requirement for both to test.
National HIV testing policy
While testing is a key part of efforts to combat HIV, the government’s policy states clearly that HIV “must always be voluntary and free from coercion”.
Although a long counselling session before testing is not required anymore, there must be a pre-testing session that gives clear information about the purpose of the test, and people have the right to refuse HIV testing.
More importantly, the right to refuse to be tested will not result in people being denied other health services.
In a written response to Health-e News, the national Health Department said it does not support any form of non-consensual HIV testing in any facility, public or private.
“We are deeply concerned by the allegations reported from Gauteng, Free State and North West, where patients or mothers were allegedly tested without consent or clarity. If confirmed, such practices are not only unethical but also contravene national policy and could warrant disciplinary or corrective action.”
Chasing targets
A senior nursing professional in the Free State said they know this is unethical, adding that their clinic is mostly attended by “illiterate people” who trust the nurses fully.
She said if the nurses view someone as “outspoken or educated”, they will not try to test them without consent.
Why are patients being forced to test for HIV?
She said nurses are under pressure from the Department of Health to achieve the UNAIDS 95-95-95 targets to end HIV as a public health threat.
The nurse further alleged that they are assessed on the positivity rate: if the people they are testing are negative, they are told they are testing the wrong people.
“We are no longer treating people clinically but according to targets,” she said.
The Health department said national and provincial targets for HIV testing are set as part of performance planning and monitoring efforts.
“However, no clinician or lay counsellor should ever compromise clinical ethics to meet numerical goals. Our focus is on targeted, demand-driven testing, especially through index testing, self-screening, and community outreach for key populations, not mass or indiscriminate testing,” it said in its response.
Damage
Dr Bandile Ndlazi, a public health specialist with a nursing background and extensive experience in HIV management, health systems strengthening and community development, warned that testing people for HIV without their knowledge or consent can set the country back.
“South Africa – and the world at large – needs to reach a point of pandemic control. And the only way to achieve this is for people to test for HIV, know their status, and those who are HIV positive to be initiated on treatment. But this must be done correctly,” he said.
“People need to be counselled, and need to understand why they are having the HIV test. Health professionals need to assess the mental readiness of patients so that they can support them or refer them for further intervention.
“Counselling is also meant to assess the community member’s source of support should they test positive.”
See more from MedicalBrief archives:
HIV testing drops after aid cuts, but Minister denies system collapse
Another 150 000 HIV infections possible by 2028 from aid cuts