Healthcare providers object to CDC's call for routine HIV tests on all patients

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Indian healthcare providers object to CDC's call for routine HIV

tests on all patients

Monday, October 09, 2006 08:00 IST

Nandita Vijay, Bangalore

Healthcare providers in India have expressed serious apprehensions

over the US Centres for Disease Control and Prevention's (CDC)

latest recommendations for healthcare providers' calling for

voluntary HIV screening as a routine part of medical care for all

patients aged 13 to 64.

The recommendations are in conflict with National Aids Control

Organisation (NACO) guidelines, which call for test with consent and

counselling. NACO is the nodal agency for HIV surveillance in India.

The recommendations, which would be issued in early 2007 in the US,

include regular tests across all hospitals to increase early

diagnosis of HIV to improve treatment and prevention. Key components

of the recommendations are screening for all patients regardless of

risk, voluntary, " opt-out " approach, simplified testing procedures

with no written consent or counselling and increased screening for

pregnant women.

Dr Jayashree Ramakrishnan, head, department of health education,

National Institute of Mental Health and Neuro Sciences (NIMHANS)

said, " The recommendations cannot be automatically adopted for India

because of serious implications. HIV is a stigma and hence suicides

will be on the rise. After diagnosis, treatment and care are grossly

inadequate. "

Echoing Dr Ramakrishnan's views, Dr K Bharathi, professor and head,

department of microbiology, Bangalore Medical College, training

coordinator, Regional Resource Training Centre and Medical Officer,

Voluntary Counselling and Testing Centre (VCTC), said, " In India, we

need to look at the psyche of the patient which is sensitive and

could lead to suicides.''

Government sources also see the recommendations as a vicious

strategy. They point out that developing countries like India by

sheer size of population could push up the sales of the products

(kits and drugs) besides become a base of patient pools for HIV drug

trials.

Sources from States AIDS Control Societies, NACO, stated that AIDS

test is a policy decision, therefore the influence of CDC

recommendations will have to be assessed from a country perspective.

" NACO guidelines are sacrosanct. It will be difficult to implement

CDC recommendations because NACO will take some time to change

guidelines,'' stated Dr. Satish Kumar Amarnath, advisor,

Microbiology, Quality Management Resource and chairman Hospital

Infection Control Committee, Manipal Hospital.

" The meaning of routine testing is regularly used but its meaning is

not very clear. Omitting consent, pre and post test counselling and

confidentiality of test results is unacceptable and against human

rights. The offer should be routine and not the test, " stated

Lakshmi Murthy, Advocacy Officer, Lawyers Collective HIV/AIDS Unit.

Safeguards that the CDC recommends such as counselling about HIV,

etc. are not workable in the Indian context due imbalance in

knowledge and empowerment between doctor and patient. The low levels

of HIV literacy among healthcare providers themselves outside of the

VCT centres, lack of infrastructure to ensure that adequate

counselling is given, etc. are other factors, averred Lakshmi Murthy.

A section of doctors feel CDC recommendations are almost like an

unofficial norm for India. There are many hospitals in the country,

which are conducting HIV tests without patient's consent or

counselling. In fact many corporate and services sectors are

conducting HIV tests as a pre employment requirement.

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