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[procaare] Durban 2000: VCT - Testing and Informed Consent

  • From: KC Team <correspondents@hdnet.org>
  • Date: Mon, 16 Oct 2000 20:36:33 -0400 (EDT)

'Testing and Informed Consent'
Session - E01
Durban, 10 July 2000

Session Report

Very few developmental and cultural gaps could have been more clearly illustrated than the juxtaposition of
papers presented by Canada's L Stoltz on 'Patient notification: an unacceptable substitute for informed
consent in the HIV testing of pregnant women' and India's M Sarvade on 'When the patient is the last to know:
Informed consent and confidentiality of serostatus in south India.'

Stoltz gave a powerful response to the US Institute of Medicine's 1998 recommendation that the US adopt a
national policy of "universal testing with notification, as a routine component of prenatal care."

Stoltz's response could be classified as typifying a well-informed, educated and independent-thinking Western
woman who objected on the grounds of contraventions of the Canadian Constitution's Charter of Rights and
Freedoms (specifically S7 and S15). These entrenched rights are violated because the recommendation is not in
accordance with the principles of fundamental justice, liberty and security of person as well as contravening
the equal protection and equal benefits of the law without discrimination based on sex (gender).

Sarvade's presentation proceeded gently, including slides of the gynaecological clinic conditions in south
India, showing high density occupation, not only in waiting and administration rooms but most importantly,
even in the consulting/examination rooms where patient doctor intimacy and confidentiality is almost
impossible. Additionally he emphasized not only gender inequality in family and the wider community but
stressed that often the spouse, mother-in-law or even the community might indeed know of the woman's HIV
status before she herself was even informed.

A most insightful question around the issue of developing culture-specific counsellor training was asked by
Deborah Boswell, from Kara Counselling, based in Lusaka, Zambia. She hit the nail firmly on the head because
she commented that no universal approach could be applied but that women's rights needed nevertheless to be

The human rights contraventions developing around other areas of testing and abuse of rights were highlighted
by South Africa's C Ngwena in 'HIV tests in the military: South Africa's double standard approach.' He
described compulsory HIV testing as part of the health entrance qualifications with positive results meaning
immediate disqualification. This was not only a violation of SA's entrenched Bill of Rights but also at
variance with any notion of equality, because soldiers already employed in the SA National Defence Force are
not tested.

France's J-M Faucher followed the theme of inequality and discrimination against HIV positive citizens by
highlighting that while the national social security system covered the costs of HIV-related illness,
insurance companies had leapt onto the band wagon and were using HIV testing to block the life insurance. This
coverage is required by financial institutions, thus making even the most modest loans impossible.

AIDS2000 Key Correspondent
E-mail: correspondents@hdnet.org
(Coordinated by H&D Networks: www.hdnet.org)

For other Durban 2000 session reports, please go to www.hdnet.org

[*VCT = Voluntary Counselling and Testing]

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