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Are we heading towards mandatory HIV testing?

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Dear All,

Concerns have been raised in different fora (read forums if you like) about

over- enthusiastic promotion of HIV testing in resource limited settings with

low prevalence of HIV.

Efforts like PITC (Provider Initiated Testing and Counselling) which mention

TESTING before an apologetic COUNSELLING following it (perhaps just to make it

politically correct), have been perceived that way.

Some recent recommendations include testing for HIV infection in the United

States with expanded screening in all health-care settings for all persons in

the age group of 13 to 64.

They appear to be in the form of expanded HIV screening for patients regardless

of risk and with decreased emphasis on prevention counselling.

In other set ups post test counselling issues have been facilitated in health

care settings only missing out the potential role of possible reaching out and

follow up services as integral part of post-test counselling facilities.

Different messages are passed when the funding organizations and other

authorities put questions about the number of NGO functionaries and personnel

working in organizations /HIV implementers which have got themselves tested for

HIV suggesting an implicit promotion of HIV testing of all with or without any

risk perception (real or perceived).

Prevention of HIV infection is based on primordial prevention unlike most of the

diseases which rely on secondary prevention necessitating early diagnosis and

prompt treatment form public health point of view besides treating/curing the

individual cases.

Interventions for promotion of an discriminatory HIV testing in resource poor

countries with low prevalence of HIV may not be cost-effective.

There is a likelihood of increased stigma and discrimination as the people

tested to be positive may not get any benefit immediately and may be denied the

services which they want to avail at that point of


There was a medical practitioner in a city in India who perceived the PITC as a

license for mandatory HIV testing now that the " voluntary " component has been

dropped(sic) from the Counselling and Testing Centres(misinterpretation of

changed nomenclature from VCTC to ICTC) through which the " DOCTORS CAN PROTECT


Efforts must be made in a directed manner that any such measures are not

misinterpreted and do not add to stigma and discrimination and denial of

services to the PLHIV .They must be in accordance with the rights perspective in

an unequivocal ethical manner.

Increasing demands for organization of camps for HIV testing at different

quarters must be seen in this light of perceiving HIV infection vis a vis

diseases needing secondary prevention

View and suggestions are invited from the members on these personal concerns.

Rajesh Gopal.

e-mail: <dr_rajeshg@...>

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