Sheryl Ubelacker
Canadian Press

HIV testing can have severe consequences, especially for women: Robinson

TORONTO — Routine HIV-screening may help prevent the spread of the disease in hard-hit countries, but receiving a positive diagnosis without counselling and followup programs can leave individuals devastated in countless ways, the International AIDS Conference was told Wednesday.

"There have been a number of sessions and press conferences at this particular conference in which high-profile speakers have backed or even supported enthusiastically the scaling up of routine opt-out testing," said Mary Robinson, former president of Ireland and a women's rights advocate.

"Scaling up HIV testing isn't a simple matter, and especially for women, and HIV-positive women know this very well," she said.

"Routine testing in Africa can lead to negative consequences," said Robinson, patron of the International Community of Women Living with HIV-AIDS.

Testing that results in an HIV-positive diagnosis can mean women are blamed for bringing HIV into the family, "even when their husband may very well have infected them, just because the woman was tested first," she said.

"I've heard this again and again: 'She's the one in the family, so it must be her. She's to blame, out she goes.'"

Robinson said women who disclose their HIV-positive status are often subject to verbal and physical violence. "And, I'm afraid to say … sometimes terrible violence."

Grace Sedio, an HIV-positive woman from Botswana, said her country offers routine "opt-out" HIV screening, under which patients can choose not to have the test.

But many women don't realize they can refuse to undergo screening or are too intimidated to challenge health providers who say they should comply, she said.

In Botswana, "all your decisions are based on the service provider," said Sedio. "HIV prevalence is high in Botswana and when you're offered routine testing, you think in the back of your mind, 'This is the right thing for me to do,' not necessarily being ready or that you want to do that."

Women who test positive are often sent home to their families and told to come back in several months to have immune cells, called CD4s, and viral loads tested. If they have reached certain levels, the health system will provide antiretroviral drugs.

But what's missing from HIV testing, Sedio said, is counselling about what a positive result means — including devastating emotional reactions a person may experience and the stigma and discrimination they likely will suffer when family, friends and neighbours find out.

"Women really don't know what is ahead," said Robinson. "They need to sit down and be listened to."

Robinson said counselling before testing — the opt-in position — is about dignity and human rights.

"Otherwise, you're treating people almost like cattle. You know, 'Let's test them unless they positively protest."'

Joe Amon, director of HIV-AIDS programs at Human Rights Watch, said there is growing tension between those pushing for routine HIV testing from a medical perspective and those in communities affected by HIV-AIDS.

"Currently less than one per cent of adults in the world have access to voluntary counselling and testing." he said. "And everyone agrees that that figure has to be increased and it has to be increased dramatically.

"The testing creates a moment when there can either be trust and a relationship with health-care provision or it can be a moment when people are turned away or they don't want to come back.

"And that's why it's critical that there be counselling and there be an opportunity to build a relationship for chronic disease care over the long term."

© The Canadian Press, 2006