Testing rights

In healthcare, prevention is always better than a cure but proposals by the Health Minister to introduce universal testing for HIV/AIDS among university students and those seeking to enter public service could have severe negative results as they run the danger of being discriminated against based on the results of their tests. Moreover, international best practices decree that mandatory testing should only be done in countries with high prevalence of HIV/AIDS and for specific groups such as pre-natal women with complete assurance of privacy.

People who do not undergo testing remain ignorant of their status and they could continue to spread the infection in the community, which has resulted in rethinking of testing strategy in some countries to bring out and emphasise mandatory testing which has reasonably gained more attention in the past decade, but again, this is largely for vulnerable groups such as women planning to have babies or sex workers. 

Mandatory testing is testing the HIV status of a person without consent, confidentiality and privacy so that the test result (either positive or negative) could be linked to identify the person. This mandatory testing is in contrast to the unlinked anonymous testing which is done in HIV sentinel surveillance. Usually mandatory testing is recommended only for screening of blood, or biological tissues to prevent transmission of HIV to the recipient. So for example people who donate blood should have their samples tested before being stored in the blood back. Such efforts have already been implemented in Sri Lanka for decades.

Mandatory testing among high risk groups especially sex workers is not advised because it drives them underground due to fear and stigmatisation, thereby making it more difficult to implement interventions. In the control of HIV epidemic among the key population, it is always better to implement HIV testing voluntarily with pre- test and post- test counseling so that there is informed consent, confidentiality and privacy guaranteed for the individual.

In March a student was rejected from a school because he was suspected of having HIV despite tests conclusively proving to the contrary. Despite massive public outcry parents removed their children from school and it took a Supreme Court order to ensure that no child would ever have to face such heartbreaking discrimination in the future. With such weak legal and social frameworks in Sri Lanka, how can the Government guarantee there will be no stigmatisation and victimization? Would students still be allowed into university? Would workers get the same positions and promotions as their non-infected counterparts?

For Health Minister Dr. Rajitha Senaratne’s proposal to even stand a chance of acceptance, it must come with a Privacy Act, ensuring the results of all such tests are only shared with the individual. But the very difficulty of implementing such a system for over a million university students and potential public workers is fraught with complications. When privacy cannot be guaranteed how can mandatory testing in a low-prevalence country be justified?

HIV/AIDS testing should be a part of a larger strategy to address the problem of HIV infection provided there is accessibility and continuity of health services for management of the disease. By casting the net too wide, not only is the Health Minister in danger of wasting precious resources testing people who are unlikely to have the infection but also creating the very real possibility of severely infringing of people’s rights.