HIV testing can have severe consequences, especially for women

14:25:29 EDT Aug 16, 2006
Canadian Press: SHERYL UBELACKER

TORONTO (CP) - A recurring theme at the International AIDS conference this week has been the issue of HIV testing - a tool many say should be ramped up in AIDS-ravaged countries to keep the disease from spreading. But others - among them, former president of Ireland, Mary Robinson - are preaching caution about widespread testing programs, saying the fallout from receiving an HIV-positive result can be devastating in countless ways, especially for women in developing countries.

"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," Robinson told a media briefing Wednesday.

"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."

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, meaning that people can choose not to have the test.

But many women don't realize they can refuse the test or are too intimidated to challenge health providers who say they should take it.

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.

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.

Amon said confidentiality and counselling must be part of testing programs because they are basic human rights.

"Stand-alone HIV-testing programs that don't have linkages to care and treatment, that don't have linkages to information and counselling, that aren't integrated and providing a comprehensive program that also addresses stigma and discrimination will not succeed at empowering individuals to do something with the information about their status."