Residents in at least three provinces say they have been coerced into doing HIV testing at various government health facilities. People Health-e News spoke with in the Free State, North West, and Gauteng say the testing is done without counselling before or after. It is further alleged that in some of the clinics, an HIV test is a prerequisite for receiving any health services.
Most of the healthcare users spoke on condition of anonymity for fear of being refused medical treatment in future. Many say they are not opposed to being tested for HIV, but took issue with not being given more information about the process, as well as counselling.
“Last year I came to Sandown Clinic because I had the flu. I was sent to different posts, and one of the rooms was for the HIV testing,” says a woman we spoke with during a visit to the clinic last week. “I guess it’s a good thing, but they have to explain the procedure to the patients and why the test is required.”
We spoke to several other clients at Sandown clinic in Sandton who share similar experiences. One patient says that she received health services at the clinic, which includes HIV testing. We asked if anything was explained to her, and she said, “They just test you with no explanation.”
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At Hillbrow clinic, a patient says this is a common practice. “When you come to the clinic, you have to take it [HIV test] by force. They also do the TB test. Even the children are tested for HIV, that thing is offensive, and also unusual that they test the child for HIV.”
At Yeoville clinic, one patient explains that they are told to get an HIV test if they haven’t done so. “It’s a must to test for HIV because you cannot be helped if you haven’t done it.”
In the North West province, patients also claim that they are tested for HIV without consent, and that for mothers with babies, it is a requirement for both to test.
National HIV testing policy
South Africa has the largest HIV epidemic in the world, with around 7.8 million people living with the virus. Testing is a key part of the country’s efforts to combat HIV. But the government’s policy states clearly that HIV “must always be voluntary and free from coercion”. While a long counselling session before testing is not required anymore, there must be a pre-testing session that gives clear information about the purpose of the test, and that people have the right to refuse HIV testing. More importantly, the right to refuse to be tested will not result in people being denied other health services.
In a written response to Health-e News’ queries, the national health department says it does not support any form of non-consensual HIV testing in any facility, public or private.
“We are deeply concerned by the allegations reported from Gauteng, Free State, and North West, where patients or mothers were allegedly tested without consent or clarity. If confirmed, such practices are not only unethical but also contravene national policy and could warrant disciplinary or corrective action.”
Chasing targets
A senior nursing professional in the Free State confirms that they know very well that their actions are unethical. She says their facility is mostly attended by “illiterate people” who trust the nurses fully. She says if the nurses at her facility view someone as “outspoken or educated”, they will not try to test them without consent.
Why are patients being forced to test for HIV?
“Pressure” from the National Department of Health to achieve the UNAIDS 95-95-95 targets to end HIV as a public health threat. To do so, countries must ensure that by 2025, 95% of people with HIV know their status; 95% of those with an HIV status are on ART; and that 95% of those on ART have an undetectable viral load.
The nurse further alleges that they are assessed on the positivity rate; if the people they are testing are negative, they are told they are testing the wrong people. “We are no longer treating people clinically but according to targets,” she says.
According to the department, national and provincial targets for HIV testing are set as part of performance planning and monitoring efforts.
“However, no clinician or lay counsellor should ever compromise clinical ethics to meet numerical goals. Our focus is on targeted, demand-driven testing, especially through index testing, self-screening, and community outreach for key populations, not mass or indiscriminate testing,” the department says in its response.
Knock-on effects
Dr Bandile Ndlazi, a public health specialist with a nursing background and extensive experience in HIV management, health systems strengthening and community development, warns that testing people for HIV without their knowledge or consent can set the country back.
“South Africa – and the world at large – needs to reach a point of pandemic control. And the only way to achieve this, for people to test for HIV, know their status, and those who are HIV positive to be initiated on treatment. But this must be done correctly,” he emphasises.
“People need to be counselled, and need to understand why they are doing the HIV test. Health professionals need to assess the mental readiness of patients so that they can support them or refer them for further intervention. Counselling is also meant to assess the community member’s source of support should they test positive.”
Ndlazi says those testing negative also need to be monitored to prevent HIV infection in future. – Health-e News
