South Africa: Government to Consider Routine Testing

The South African government is considering whether to make HIV tests routinely available at public health facilities. Individuals wishing to know their HIV status currently undergo voluntary counselling and testing (VCT) but only 850,000 South Africans - in a population of around 45 million - have been tested in the past four years.

Views on testing have begun to shift: last year Botswana became the first African country to introduce routine testing in its health sector, with Malawi and Lesotho following suit. The hope is that by offering HIV testing as a routine part of treatment, more people will be encouraged to discover their status and, over time, stigma will lessen.

UNAIDS and the World Health Organisation have issued a new policy on testing in support of this approach, which includes the right of patients to 'opt out'.

At present South Africa does not have a policy on routine testing, and would have to "carefully consider what needed to be implemented", Dr Nomonde Xundu, chief director of the national HIV/AIDS unit, told PlusNews. Health department officials met last week to discuss whether routine testing would be an appropriate strategy.

According to Xundu, hospitals and clinics already routinely offered HIV tests to patients in high-risk groups, such as people with tuberculosis, sexually transmitted infections (STIs), pregnant women and migrant workers. The government was hoping to "learn lessons from Botswana", she added.

Routine testing was introduced in Botswana in 2003, when less than 8 percent of its population of 1.6 million knew their HIV status. Officials claim that the number of individuals willing to be tested has risen by up to 90 percent since then, with few making use of their right to 'opt out'.

However, the Botswana Network on Ethics, Law and HIV/AIDS (BONELA) has criticised the government for failing to launch a public information campaign on the new policy, arguing that routine testing was only acceptable if patients knew they could refuse.

South African AIDS activists have argued along similar lines. Jonathan Berger, head of the law and treatment access unit of the Johannesburg-based AIDS Law Project, warned that while every effort should be made to encourage people to know their HIV status, the right to decide whether to be tested had to be protected.

Routine testing would only be acceptable if informed consent, counselling, confidentiality and access to treatment were guaranteed, Berger noted. The government would also need to ensure that health service providers did not discriminate against patients who 'opted out'. Moreover, a shift in testing policy would only make sense if the government simultaneously improved access to antiretroviral (ARV) treatment. "Even with very low testing rates, ARV waiting lists are long," Berger observed. The new strategy would be more effective in Botswana, he added, as the country provided ARVs to about 65 percent of its HIV-positive population, while in South Africa only 10 to 14 percent of those who needed treatment could access it.

Thaddeus Metz, Associate Professor in the Philosophy Department at the University of the Witwatersrand in Johannesburg, pointed out that routine testing could strike a more constructive balance between individual rights and the need to monitor and contain the epidemic. Introducing the policy "would save lives", as people who knew their HIV status could reduce transmission rates and access information and services to stay healthy, Metz said. Routine testing required health workers to inform and counsel patients about HIV testing, and the question remained: would South Africa's overburdened health system - already crippled by staff shortages - be able to cope? Xundu admitted that if routing testing were to be introduced, an "intense training and information campaign" for both healthcare workers and the general public would have to be undertaken.