HIV: Talk before you test

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HIV: Talk before you test

GEETANJALI PATOLE

TIMES NEWS NETWORK [ SUNDAY, FEBRUARY 17, 2002 11:37:50 PM ]

ackling the threat that HIV, and subsequently AIDS, poses for a

developing country like India is proving to be a varied challenge.

Besides the enormity of awareness programmes that are required to

make sure the prevent-HIV message gets out to the masses, the

population of our cities, including Pune, is forcing doctors and

social workers to neglect a very crucial aspect while preventing the

HIV juggernaut from rolling on.

Even though the Indian Medical Association (IMA), has guidelines that

make it mandatory for anybody taking an HIV test to receive pre-test

counselling, this is not happening in Pune.

While on the face of it, pre-test counselling may seem an expendable

process, it is often what can make all the difference between life

and death for the person taking the HIV test.

Which is why pre-test counselling is de rigeur in medical facilities

the world over and admitted to, as a necessity, even by HIV experts

in the city. Most hospitals in the city this reporter visited were

not equipped with counselling cells to provide any such facilities.

A standard pre-test counselling procedure assesses the patient's risk

factor through a series of queries and prepares him/her to accept the

test result confidently.

Dr Sanjay Mehendale, deputy director of the National Aids Research

Institute (NARI), said that pre-test counselling was perhaps one of

the most important aspects of any HIV/Aids awareness programme.

" Testing for HIV can put the patient through enormous stress and

trauma, since a lot of fear, stigma and dread is attached to the

disease. Whether the result is positive or negative, it is essential

for the patient to go through a thorough pre-test counselling, "

Mehendale said.

According to the IMA guidelines a pre-test counsellor is first

supposed to make the patient familiar with all the procedures

required for the HIV test. The counsellor is then supposed to ask the

patient why s/he has decided to go in for a test. If the patient has

had a history of high-risk behaviour involving drugs, multiple sexual

partners, homosexual contact, blood transfusion, etc., the counsellor

has to explain the degree of risk to the patient.

Preparing the patient to accept the result is the next part of the

procedure. After the patient is informed about the various medical

facilities that have made it easier for someone to live with HIV,

s/he has then to be asked permission to carry on with the HIV test.

Dr Vinay Kulkarni, HIV physician for Jehangir hospital, acknowledged

the importance of pre-test counselling. However, he claimed that

logistically, in Pune, it was not possible to counsel every patient

that goes through an HIV examination. " We give pre-counselling to

patients who volunteer for an HIV test. But for patients that are

undergoing surgery, we usually suggest a rapid screening since there

are more important factors that need to be taken care of. However, in

this rapid testing if we do discover an HIV positive case, we then

refer them to a counsellor before the news is broken, " he informed us.

Noted HIV expert Dr Sanjay Pujari also cited the sheer number of

people going in for test as the reason for the absence of pre-test

counselling for HIV. " The number is so mind boggling that the

hospital authorities cannot cater to all the patients that go in for

a test. Besides, the tradition of medicine in India has always been

very fraternal. The physician always has an upper hand in medical

matters and the patient rarely objects to what the physician

suggests. If the patients know their rights, they can demand pre-test

counselling, " Pujari said.

According to Dr Mehendale, the importance of pre-test counselling

cannot be neglected. " There is hardly any investment required to set

up a pre-test counselling office. Even the counsellor doesn't need a

formal degree. We at NARI provide regular training programmes where

we train volunteers to become effective HIV/Aids counsellors. If the

hospitals are running short of staff they can always turn to us, " he

suggested.

The situation puts the onus on the person going in for a test. One

will be well within one's rights to request for a counsellor before

taking the test. It could make all the difference.

geetanjalipatole@...

http://www1.timesofindia.com/articleshow.asp?art_id=1298454 & sType=1

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