Regarding concerns of the medical community on the draft legislation on HIV/AIDS

[Guest guest]

This is in response to the email dated 4 March 2003 that appeared on the

list serve titled 'Medicos oppose legislation on safeguarding rights

of HIV patients'. The email was posted from Express Health Care by Dr. E.

Mohammed Rafique.

Lawyers Collective HIV/AIDS Unit would like to issue certain clarifications in

this regard. The article written by Rita Dutta of Express Health Care

unfortunately portrays a misinformed, incomplete and inaccurate picture of the

process and substance envisaged for the draft legislation on HIV/AIDS being

undertaken by Lawyers Collective HIV/AIDS Unit.

At the outset we would like to clarify that the legislation is not being drafted

by a '10-member committee of the NGO Lawyers Collective' but by lawyers working

on the staff of Lawyers Collective HIV/AIDS Unit, a part of Lawyers Collective.

However, the legislation is being overseen by an advisory working group, which

includes Meenakshi Datta Ghosh, Project Director, NACO, Kapil Sibal, Member of

Parliament and Lawyers Collective HIV/AIDS Unit.

More importantly, although the prime objective of the legislation would be to

protect the rights of people living with HIV/AIDS (PWA), the attempt will

certainly be to ensure that the rights of healthcare workers (HCW) are

protected, particularly the right to a safe working environment (which would

include availability and accessibility to universal precautions). In our

experience, the guarantee of safe working conditions would contribute to the

reduction of baseless fear and discrimination towards PWA in healthcare

settings. Our experience also reflects that the healthcare worker most adversely

impacted by the lack of universal precautions is from the lower cadre (ward

boys, lab technicians, nurses etc.)

It is well established that the guarantee of human rights and their realisation

is the best way in which to deal with the HIV/AIDS epidemic. Methods of

mandatory testing, disclosure of status and segregation have been seen to be

universally unsuccessful in controlling the spread of HIV/AIDS and consequently

been dismissed as public health strategies. They have worked adversely by

pushing people away from health services and driving the epidemic underground.

There are sound rationales for the implementation of a rights-based approach to

dealing with HIV/AIDS. The impetus for the formulation of such an approach has

been due to various factors not the least of which is the unprecedented stigma

and discrimination that has been created by HIV/AIDS. This is an epidemic that

requires particular attention and a novel response, where those infected,

affected and at risk are assured the security of services and the humanity of

law and society. This humane response needs to come first and foremost from an

informed and dutiful medical community. In our experience there are several

physicians who practice such an approach and lead the way in setting standards

of care and excellence in the medical fraternity particularly and their

community generally.

However, there are many who believe, primarily out of fear and ignorance (but

also due to abysmal working conditions) that PWA should not be provided

treatment and care. For those who deny this fundamental service out of fear and

prejudice, there can be no justification. For those who deny it due to lack of

safety at the workplace, the legislation will aim to adequately address this

situation in a manner by which the use of precautions becomes a routine practice

regardless of HIV status of the patient.

It is surprising that at this time, 20 years after the start of the epidemic and

in light of the gross violence, prejudice and denial of rights of HIV+ people in

India (chaining of PWA in cages, expulsion of children from schools, the beating

and killing of PWA), the question is still being asked as to why those living

with HIV/AIDS are being treated differently from others. The reasons for special

measures should be self-evident. That the medical community, which should be

most knowledgeable of the minimal chances of occupational exposure, is

questioning this special attention is even more disappointing. It is also

reflective of the abject lack of information available to healthcare workers.

Lawyers Collective HIV/AIDS Unit has undertaken several interactions with

healthcare institutions in the last several years where the attempt has always

been to understand the predicaments of the healthcare community, respond to

their concerns and also inform them of their rights and duties. We are glad to

say that many of these interactions have been successful in changing the

perspectives of many healthcare workers. With those who reject our rights-based

approach to HIV/AIDS, we persist in interacting.

The draft legislation process will attempt to continue this interaction. Lawyers

Collective HIV/AIDS Unit feels that before lawmakers are presented with the

draft legislation it must receive due consideration from the medical community

and others. With this in mind consultations are being planned where ideas can be

shared and views expressed and discussed. We hope that representatives of the

medical fraternity use this opportunity to engage in constructive debate on the

proposed law and look forward to responses at aidslaw@... from those

healthcare workers/ representative bodies who would like to be part of this

process. As Dr. Ajithkumar from Thrissur said earlier on this list serve, if

doctors stop discriminating against PWA, HIV/AIDS will cease being sacrosanct.

With the cooperation of the healthcare community and civil society generally,

the law can play a key role in fostering this environment.

Vivek Divan

Lawyers Collective HIV/AIDS Unit

E-mail: <aidslaw@...>