Re: Ethical issues in HIV screening in Villages

[Guest guest]

Dear Forum Members,

As you are well aware that the AIDS epidemic has spread to the general

population in addition to the high risk groups and into the villages, the

testing and screening for HIV has become imperative even in villages. The health

care system in villages is far from ideal unlike the situation in the developed

countries where the system comes to the aid of both the doctor and the patient.

Screening in villages is difficult because of illiteracy and prevailing cultural

beliefs.Let me give you an example of my expeirence while working in a hamlet

called LK Tanda ,situated near Nandyal in AP. Even today a woman in labour is

forced to travel in 7 bullock carts to accelerate labour pains. An OBG doctor in

a medical camp with me admitted that her grand mother died during one such

misadventure ! When one is dealing with a social group as backward as this and

as illiterate as this, the question of application of ethics becomes

complicated.

Let us take the issue of " informed consent " . Usually in towns and villages you

come across two kinds of patients. The first group consists of men brought by

their spouses with symptoms suggestive of AIDS ,where the woman requests for HIV

testing.Here the question of consent becomes easy. The second group consists of

people who have been evaluated for preop and found positive for HIV and

abandoned by medical professionals immediately. In the second group the

patient's consent is never taken. They form a sizeable portion of patients with

HIV. They are ignorant about their disease and its consequences.

In our screening camps social workers have gone form house to house,familiarized

the villagers with symptoms suggestive of AIDS. The women members of the family

in turn had convinced their men folk to go in for HIV screening and they

themselves volunteered for testing.It has been our experience that women have

been more pragmatic. Let me assure you that there was no coercion

involved,covert,overt or otherwise. Let me admit that it is a time consuming

process.

Let us move to the issue of confidentiality. Though doctors and social workers

keep the records confiidential, the word goes out in the village about the HIV

status of the individual. I have found that the situation has improved

marginally from what it was a decade ago.People are willing to accept others

with HIV living amidst them.

Regarding pre test and post test counselling, the situation is far from

satisfactory. We have social workers with little knowledge of Psychology.Hence

they lack adequate training in counselling AIDS patients. Lot of work needs to

be done in the area of psychological and sexual rehabilitation of the HIV

patient and his family in villages.

As a doctor who has worked in the west, I have found many lacunae in this

system.As the disease is rampant and spreading fast in the villages,I have tried

to be as ethical as it was possible for me.

Madhukar

E-mail: <madhukurnool@...>

[Guest guest]

Dear Forum Members,

Screening in vilages is definitely tough. But what increases the stigma

is people from " outside " coming in doing indiscriminate testing, and

worse still letting out half-messages that confuse people and further

infuse in them the fear of HIV. Two such cases have come to light

recently, and I wish to share the same with the members.

Case 1. In Mangampet, Kadapa District of AP a team of Government Doctors from

Kodur, Rajampet and Kadapa conducted a medical camp in July. They had

their own suspicions about a PLHA. They returned subsequently last month

in a jeep and stopped the person near his house and started checking

him. When curious passers-by stopped, it seems the doctors waved them

away stating don't come near him, be away. We came to know about this

incident when PLHA himself narrated in a positive people's group

meeting.

Without as much as uttering the word AIDS aloud, they had conveyed the

man has the virus. From that day onwards his problems have started.

People go out of the way to avoid him. When he walks on the road, people

skirt around him and go to the otherside of the road. Some people have

offered to pay him Rs. 2000/- if he leaves the village.

We have assured the PLHA that he need not move out of the village. We

have spoken to the villagers and are planning to conduct a HIV/AIDS

awareness meeting in the village. But the PLHAs problems started with

the doctors breaking confidentiality. So much for sensitizing them to

the issue.

Case 2. In a village near Palamaner, Chittoor District, a couple days ago,

the Police department conducted a health camp. During the camp, it seems

the doctors found a couple with acute stomach pain and suspected the

worst. The Police, as reported in a paper dated 9th September have

announced the names of the couple and have said that they both would be

sent to Govt. hospital to be tested for HIV. Forget about informed

consent, pre and post test counselling, here is a situation of blatant

announcement and publication names of suspected PLHAs. Merely on

suspicion. Imagine the stigma they now have to bear.

So we find that, by our experience, the people from urban settings, who

invade into rural areas, ostensibly to do good, end up doing more harm.

This is done purely due to an utter disregard to ethics.

Meera

Sreeram

E-mail: <rmeera102@...>

[Guest guest]

Dear Forum,

I read Meera's article about what happened in the two villages . What happened

in this case was unprofessional and down right unethical. But the problem is

not urban people coming to the village and doing testing. The problem is people

without any training for VCTC doing the same. The same result

would have happened if local people without any training for VCTC would have

done HIV testing.

I don't know whether NACO had any policy or guidelines regarding VCTC. If they

do, I don't know how this can happen. If they don't, it is high time these

policies and guidelines are developed and strictly enforced.

Sathi Dasgupta.

E-mail: <sathi_dasgupta@...>