Medicos oppose legislation on safeguarding rights of HIV patients

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From Express Health Care:

Medicos oppose legislation on safeguarding rights of HIV patients

By Rita Dutta - Mumbai

National Aids Control Organisation's (NACO) move to bring in a legislation

to safeguard human rights issues of HIV/AIDS patients in the country has

drawn adverse reactions from the medical community.

The new legislation - drafted by a 10-member committee of the NGO Lawyers

Collective - is likely to be tabled during the forthcoming Budget session of

the Parliament. The legislation aims to address controversial issues such as

patient consent for HIV testing, discrimination and segregation of HIV/Aids

patients, confidentiality issue and pre and post test counselling, says

Vivek Divan, project co-ordinator of Lawyers Collective's HIV unit. The

committee would be consulting with NGOs working in the areas of HIV/Aids,

medical and paramedical community and patients before drafting the

legislation. The draft will be approved by NACO and ICMR before it is

tabled, says Divan.

The legislation is expected to make voluntary consent of the patient

mandatory on the lines of NACO's National Aids Prevention and Control

Policy, 2002. The legislation would be implemented by NACO. According to Dr

D V Vaswani, deputy director, care and support group of HIV patients, Mumbai

Districts Aids Control Society and a NACO official, " Reportedly 90 per cent

of the private practitioners conduct HIV tests without taking the consent of

the patient. " True, admits hospitals and nursing homes authorities, that

they do conduct HIV test among an array of tests before conducting surgery

irrespective of the patients' will, as they feel that the prerogative of

testing should be vested with the authorities and not patients.

Doctors point out that they immensely depend on the Aids test, as the doctor

and the paramedical staff would need to be take extra precaution while

operating on an HIV patient. Says gynecologist Dr Duru Shah, consultant at

Jaslok Hospital and president, Mumbai Obstetrics and Gynecological Society,

" If we are supposed to treat patients who refuse HIV test, then it would be

tantamount to safeguarding the rights of the protected at the cost of

exposing the protectors' life to the risks of getting infected during the

surgery. "

According to Dr Ketan Parikh, president of Association of Medical

Consultants (AMC) and joint-partner of Tara Neo-Surg Nursing Home,

unnecessary hullabaloo is being created about the rights of Aids patient,

when according to the law the bearer of any communicable diseases is to be

identified to prevent transmission. " What is so sacrosanct about AIDS

patient? Why should they be treated any different from patients suffering

from any other communicable disease? It should be left to the doctors to

decide whether AIDS testing should be conducted? " avers Dr Parikh.

With chances of an HIV positive mother delivering an HIV positive child is

an alarming 80 per cent, Dr Shah points out that conducting compulsory HIV

tests for pregnant woman ensures that the patient takes medication for the

safe delivery on a non-HIV child.

Doctors are apprehensive that the legislation would compel them to use HIV

kits, costing Rs 1,000, an expense which can be avoided by doing the simple

spot Aids test, which costs not more than Rs 100. " Most of the nursing homes

do not use the universal norms of conducting a surgery, whereby one is

supposed to use double boots, double gloves and other such precautions to

shield themselves from HIV infection for the extra cost involved. Forcing us

to use the kit would only add up the expense of the treatment, " said Dr

Parikh.

Dr Vaswani rubbishes the voices of medical community by saying, " Why doctors

should single out HIV test, when there are other deadlier disease like

Hepatitis B? Doctors should rather conform to the universal norm of surgery

than impose an HIV test on somebody? "

The legislation also gives rise to the question as who would counsel the

patients? " A big hospital is more like a nursing home, where the basic tests

are conducted by the consultants before they are sent to us for referrals.

Hence it is the consultant who has to deal with the counseling, " opines

Major General Vijay Krishna, CEO, Breach Candy Hospital. Consultants say

thay are ready to wear the mantle of counselors, provided that the law

mentions what should be done in instances where the patient refuses to

undergo the test even after counselling.

According to paediatrician Dr Bhupendra Avasthi, consultant at Lilavati

hospital and attached to Surya Nursing home, " The hospital and nursing home

authorities should be vested with the power of refusing the patient when

patients refuse to undergo the test, even after counselling. "

The legislation of 'integrating the patient " does not gel well with the

medical community, with HIV patients who have a high risk of tuberculosis.

" The tuberculosis that an Aids patient would trasmit is the most virulent

form and hence we have to take precaution to segregate him, " says Dr Parikh.

Some point out that the legislation would put the hospital authorities in a

difficult situation, with hospitals being compelled to go by the book,

against the will of relatives of non-Aids patient. Says Prakash Mhatre,

director-operations, Lilavati hospital, " We are extra cautious about not

disclosing the HIV status of the patient. However, most of the times, we are

forced to segregate patients because the relatives of other patients find

out about the status. "

He added that the legislation would result in patient being dissatisfied

with hospital administration. One medical expert even pointed out that such

a legislation would only benefit the different NGOs working for Aids, who

needs to create hullabaloo for their own vested interests.

NACO officials retaliate saying that when Aids patients are discriminated,

it is the responsibility of the hospital authorities to educate the public

about the correct way of transmission. Even LC is undeterred by the

resistance to be faced from the medical community. " It is a challenge to

convince the hospitals and medical professionals about the importance of the

legislation and make them abide by it, " quipped Divan.