SOCIAL media has been buzzing in unprecedented fashion since August 15 when republican President, His Excellency, Mr Edgar Chagwa Lungu announced that Zambia would now follow a routine HIV Testing, Counselling and Treatment policy.
It has so far been a week of lots of laughter evoked by jokes coined out of this policy shift by the Government with Zambians seizing the moment to show some rare creativity by coming up with hilarious posts such as:
I have opened a drug store. Panadol is K25. If you think I am expensive, please go to the clinic; ba honourable come back we test you … just a minute young man. Let me just lock the car (while setting off in a sprint); even those at bedsides at hospitals waiting for their sick relatives will now be subjected to tests; the National Road Fund Agency has partnered with the Ministry of Health to test all motorists from toll gates; the Ministry of Religious Affairs is working with various churches in order to catch those who may be trying to evade the test by attempting to go and hide in the church; apart from checking for vehicle road worthiness, traffic police officers are now detaining motorists who fail to prove that they have tested; there is no more privacy as employees’ sick notes will now be accompanied by one’s HIV status; the Ministry of Health has also partnered with Hungry Lion and customers will be subjected to tests as they wait for their orders.
I must say that it is admirable that Zambians have spiced up this very important national matter with such creative humour which is in fact indirectly acting as an effective method of creating awareness around the new measure. The humour has, to an extent, also helped lighten or remove the heaviness that issues of HIV and AIDS tend to come with.
On the other hand, there has been serious talk with some arguments, for and against, being advanced. One interesting line of argument that has been proffered by those against the President’s pronouncement is that routine testing is against one’s rights.
This argument raises questions of objectivity as it makes one wonder whether this group of individuals or institutions has also considered the other side of the situation. It clearly shows from this that the only rights being championed are those of the individuals to be subjected to the test. This is being insincere. What about the rights of those that stand the risk of being infected by those whose rights we only seen to be focusing on. If one thinks that they should be left to enjoy their right to know or not to know their status, what about the right of the other person who could be unwillingly infected by those defending their own and/or rights of other infected persons? I think one cannot talk of rights of one party and at the same time ignore the rights of other parties in the same equation. Ensuring that everyone gets to know their HIV status and are put on treatment so that their viral load is suppressed is one commendable way of upholding the rights of those who could otherwise be infected. It should be pointed out and known that it is actually a criminal offence, in a number of countries, to infect another person with HIV.
The other day, someone further argued by asking why it is an issue of human rights when it comes to HIV tests and not the same thing when one has to be mandatorily subjected to tests and even quarantined if suspected to be a possible carrier of, even more vicious diseases such as Ebola.
In the midst of all this, the President has followed up his landmark announcement with an assurance that there was no need for Zambians to worry over the newly introduced policy as there will be strict confidentiality. The rights to individuals’ privacy, as most bloggers, tweeters, and other social media fanatics have been arguing is still guaranteed because their results will remain between them and the health practitioner.
It cannot be disputed that despite the mixture of HIV intervention measures that Zambia has had in place for years, there has not been commensurate success stories. The challenges or ravages posed by the pandemic are still being deeply felt by society. It would be irrational for us to continue doing the same things over and over in the hope of getting different results.
As Health Minister Chitalu Chilufya has pointed out, about 81 per cent of deaths at the University Teaching Hospital (UTH) are HIV-related and that over one million lives have been lost to HIV and AIDS over the years. Government should, therefore, not be expected to pay a blind eye to this problem when there is high possibility of nipping this problem in the bud by stopping new infections by means of treating those who are found to be carriers of the virus.
Dr Chilufya could not have put it any better when he said that the Government was merely asking its citizens to know their status and if found positive, they could then get onto free anti-retroviral treatment. This kind of treatment will reduce one’s viral load which significantly reduces or completely eliminates chances of one infecting another person.
As one who has been in the medical field hands-on before, Dr Chilufya further gives an analogy by looking at how Measles cases at the UTH were handled in the past. The 30-40 cases recorded daily were placed in an isolation ward which had been specifically set up for this purpose. A policy was later passed by Government to vaccinate children at a particular age in order to protect them from contracting Measles. This practice has continued and the Measles isolation ward at the UTH is closed because the disease has now been contained.
Similarly, since effective treatment for HIV infection became available in the late 1990s, approaches to testing have changed around the world. Guidelines from the World Health Organisation (WHO), UNAIDS and the Centre for Disease Control and Prevention have influenced policy developments in many countries. According to the WHO and UNAIDS, the two organisations in 2007 issued joint guidance on “provider-initiated” HIV testing and counselling.
They noted that previous testing strategies which relied on “client-initiated” testing (also often referred to as VCT, voluntary counselling and testing) had failed to reach enough people, both in high-income and resource-constrained countries (in Africa, just 12 percent of men and 10 percent of women had ever been tested).
The 2006 guidelines from the Centre for Disease Control and Prevention urge all people aged 13 to 64 in some states of the United States of America, to undergo HIV antibody testing as a routine medical screening test. Everyone should be tested at least once, and people at high risk of HIV infection should take an HIV test at least once every year.
Proponents of the policy highlight that there has been limited progress in preventing sexual HIV transmission, while when routine testing has been applied (blood donations, antenatal screening) the approach has been effective in limiting further HIV transmission.
In fact some global leaders, including former US President Bill Clinton, have also lent support for routine HIV testing in countries where the prevalence rate is five percent or higher. Political support for mandatory testing has been seen in countries like India, where the state government in some parts of the country at some point proposed mandatory premarital testing, and in China, which considered to test workers in certain sectors of the economy such as the tourism industry.
The Zambian government is, therefore, being responsible by making such a bold step as this will invariably come with immense benefits for the nation.
It is gratifying to note that President Lungu has not made this policy decision in a vacuum – Government has been enthusiastically rolling out projects and programmes in the health sector which have seen the on-going construction of health posts, upgrading of health centres, construction of hospitals in various districts across the country, health personnel recruitment; among others. This has taken care of some of the concerns aired by some sections, chiefly being that of the weakness of health systems in Zambia.
With the emphasis on improving education standards that the government has adopted, and now coupled with this focus on ensuring a healthy population, any development studies scholar will confirm that these are the core ingredients to catapult any country into sustainable social and economic development.
President Lungu and his government have taken an important step on behalf of the rest of the nation. Let us support them by removing the culture of poor use of health services and the widespread stigma and discrimination associated with HIV and AIDS. The success of this policy, to a large extent, lies in individual behaviour changes which cannot be brought about by a policy of routine testing alone.