/ 18 December 2009

No forcible HIV tests

No one can dispute Promise Mthembu’s assertion that we still have a long way to go towards the true empowerment of women, with or without HIV. However, some statements in her article ”Women’s power to opt out” (Mail & Guardian, December 4) cannot go unchallenged.

South Africa is a society that is perhaps more violent than others and women are undeniably more vulnerable than men. But we do not agree that as implementers of HIV prevention, care and support programmes, we ”assume that violence fades away once a woman is infected with HIV”. We are well aware of the violence, abandonment and stigma that some women face as a result of disclosing their HIV-positive status to their partners.

We need to work more closely with communities to support those affected by and infected with HIV and Aids and to deal with stigma. As we all know this cannot be achieved overnight but there have been many successes since the tragic killing of HIV-positive activist Gugu Dlamini in 1998. What Mthembu fails to do is document these successes, small as they may be.

It is untrue that pregnant women are ”forcibly tested” for HIV. If Mthembu is relating an experience in a specific facility, then she should clarify that. According to national policy guidelines, all pregnant women are offered counselling and have to give consent prior to HIV testing.

Those who refuse are not forced to test, but are encouraged to do so for the sake of their health and that of their unborn baby. This is done through the prevention of mother-to-child transmission of HIV programme (PMTCT) that government has implemented since 2001.

While we recognise that it may occur that health workers on occasion pressure women to test for HIV, this is not policy and should be opposed. The routine offer of an HIV test does not take away a patient’s right to refuse a test. Should any woman be forced into taking an HIV test, then the clinic and health workers involved should be reported to the health authorities.

The PMTCT programme is also an important entry point into lifesaving treatment for women’s health. What Mthembu’s article fails to highlight is that quite apart from the testing of pregnant women being the first step towards prevention of paediatric HIV infections, HIV is a leading cause of maternal deaths in South Africa.

So the early detection of HIV infection at antenatal clinics throughout South Africa where, alarmingly, just fewer than one in three women is infected with HIV, is a critical step towards keeping women alive through the provision of life-saving anti-retroviral therapy.

It is worth stating that many women who have voluntarily tested for HIV have, after an usually long and difficult journey, emerged strengthened from the experience. A whole generation of activists, mostly women, all committed to ending violence against women and working tirelessly for a society free of HIV as well, forms the backbone of the national treatment and prevention effort.

What greater empowerment strategy could there be in preserving life? In this respect we applaud President Jacob Zuma’s affirmation of the need for pregnant women to go on to antiretroviral therapy as soon as indicated, if HIV infected.

In addition, what we know about the PMTCT programme is that it prevents tens of thousands of babies from contracting HIV in a country where HIV prevalence among pregnant women is about 30% and where about 300 000 babies annually are born exposed to HIV.

If pregnant women were not tested for HIV, with their consent, and were not being enrolled in the PMTCT programme, then 90000 babies would be born with, or contract, HIV every year.

For proof that PMTCT can be hugely successful, one need look no further than KwaZulu-Natal, where dual therapy — the administering of nevirapine and AZT to mothers and their babies — was introduced in April 2009.

An enormous year-long study — involving 38 000 mothers at 347 clinics — has shown that the province has managed to cut HIV transmission from mothers to their newborns from 20% to 7%, an improvement of nearly two-thirds. This prompted KwaZulu-Natal’s health department head Dr Sibongile Zungu to declare that ”an HIV-free generation is both achievable and within our reach”.

We have little doubt that Mthembu would agree that this is a worthwhile and noble effort.

Lusanda Mahlasela is deputy director (PMTCT and research), Johns Hopkins Health and Education in South Africa; Yogan Pillay is deputy director general (strategic health programmes) in the national department of health; Gugu Ngubane is project manager for the national PMTCT accelerated plan, HLSP; Jack Lewis is director of the Community Media Trust; and Ashraf Coovadia is head of paediatric HIV services at the Rahima Moosa Mother and Child Hospital