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When HIV testing became mandatory

A HEALTH worker at Chipata Clinic cholera centre disinfecting residents whenever they visit the institution. The battle against cholera continues in the new year. PICTURE: COLLINS PHIRI

VIOLET MENGO, Lusaka
FEW expected the announcement, but when it came, it elicited a lot of reactions with some of them being extremely emotional and were only tempered by the memes that followed later.

The catchword became tipima, loosely translated as ‘we will test you’.
President Edgar Lungu declared HIV testing mandatory for anyone who visits a public health facility for any ailment.
The announcement was made at the launch of the HIV Testing, Counselling and Treatment Day (HTCT) on August 15, which was held under the theme “Test and treat: towards ending AIDS”.
HTCT Day, which will be commemorated annually in August, has replaced National Voluntary Counselling and Testing Day, commemorated between 2006 and 2016.
Mandatory HIV testing is being implemented to ‘fast-track’ the elimination of HIV in the country by ensuring as many people as possible get tested.
Out of the estimated 1.2 million people living with HIV, 70 percent know their status while 67 percent are on treatment and 59 percent have a suppressed viral load.
HIV testing was to be among the tests to be done on patients to ascertain their state of health in order to provide timely and appropriate remedies.
Government’s idea was that when one tests HIV positive, counselling and treatment would be done immediately.
“Protecting the life of those affected overrides the human rights argument about voluntary testing,” President Lungu said during the declaration.
He said Cabinet had debated the matter and made the decision to make HIV testing mandatory to help save lives.
“There is no need to wait for people to fall sick before they can start life-saving treatment,” President Lungu said.
It was his hope that, with the policy and other initiatives put in place, the country will eliminate HIV and AIDS by 2030.
Since the first case of HIV was confirmed in the country in 1984, about one million Zambians have died mainly in the productive age group while 1.2 million are living with the virus, out of whom 800,000 are on antiretroviral treatment.
President Lungu’s declaration was supported by United States Charge d’Affaires Christopher Craft, who said HTCT strategy was an important step in helping to attain an AIDS free generation.
But not everyone agreed.
The Treatment Advocacy and Literacy Campaign (TALC), Community Initiative for Malaria and Tuberculosis (CITAMPus), Coalition for Zambian Women Living with HIV and AIDS (COZWHA), Network of ARV Users and Zambian Network of Religious Living or Personally Affected by (ZANERELA) said the decision to introduce mandatory HIV testing was illegal and unconstitutional.
The organisations expressed deep concern that HIV testing, counselling and treatment was now compulsory for any person seeking medical treatment in public health care facilities.
TALC national director Felix Mwanza said compulsory HIV testing is illegal and unconstitutional in Zambia as both the Supreme Court and the High Court have found that consent is only present if it is provided freely, without undue influence, coercion, fraud, misrepresentation or mistake.
CITAMPIus Carol Nawina said while the policy aims to improve HIV testing and treatment adherence rates, on the contrary, coercive measures fuel stigma and drives people from health care facilities.
“Informed consent is critical to ensure that individuals are empowered in managing their health,” COZWHA coordinator Mable Mwale said. “It has been shown that an individual’s sense of self-efficacy plays a major role in how one approaches goals, tasks, and challenges regarding one’s health, with directly-evidenced clinical benefits.”
Non-Governmental Organisations Coordinating Council (NGOCC) executive director Engwase Mwale said as much as it is Government’s responsibility to ensure a healthy nation, such a pronouncement (mandatory HIV testing) does little in respecting citizens’ individual rights especially to privacy which are guaranteed in the Constitution.
The Human Rights Commission through its chairperson Mudford Mwandenga, advised Government to adhere to the United Nations guidelines on HIV testing and counselling which discourages mandatory testing.
But later, Minister of Health Chitalu Chilufya said patients could actually opt out if they do not want to test.
Dr Chilufya said in all HIV testing, the health practitioners are to seek the consent of the patients and that patients will have the option of opting out if they do not want to be tested for HIV.
“President Lungu was on firm ground to call for mandatory HIV testing because the uptake of voluntary counselling for HIV and condom use in Zambia is very low,” he said.
Dr Chilufya was indeed one of the busiest ministers in the year and did have a fair share of coverage in the news media.
He is still busy even as we start another year, no thanks to the cholera outbreak in the country.
Only on Thursday, he issued Statutory Instrument (SI) number 79 to enforce the ban of public gatherings in selected parts of Lusaka where cholera has broken out.
In line with SI 79 of 2017, a public gathering of more than five people will not be allowed in cholera-affected areas.
“It’s evident that the [cholera] situation in Lusaka is extra-ordinary and such requires an extraordinary approach in implementing required measures,” Dr Chilufya said.
“To facilitate enhanced approach [to curb the spread of cholera], Government has issued SI 79 of 2017 which mandates a public ceremony or gathering of over five people, not being a family, shall not be held in an infected area without permission from the local authority or medical officer.”
So far, cholera has claimed 38 lives, yet this is a preventable disease.
This is very sad.
However, there was still of good news for Dr Chilufya and his ministry.
The health sector saw the upgrading of health centres to first level hospitals in Lusaka.
Matero and Chilenje clinics were upgraded to first- level hospitals and were commissioned by President Lungu in May.
The upgrading of the two hospitals at a total cost of K200 million has seen a reduction in the number of referral cases to the University Teaching Hospital (UTH).
The two hospitals are now able to conduct surgical operations. President Lungu noted during the commissioning of the two hospitals that Government was committed to taking quality health care services as close to the families as possible.
Three more clinics in Lusaka, namely Chipata, Chawama and Kanyama, are earmarked for upgrading to level, one hospitals beginning early this year. This follows the signing of a K400 million financing agreement between Zambia and Japan.
Chilenje clinic had for a long time been providing health care to about 77,000 residents, but after the upgrade it now caters for more than 350,000 residents while Matero clinic served 32,000 and now it caters for 400,000 people.
The phase one of the two hospitals included construction of the general outpatient department, emergency and security wings, maternity ward for both women and new born babies and medical imaging department with X-ray and ultra-sound, including related facilities such as a pump room, cylinder and generator room, transformer, elevated water tank and water reservoir and administration block with offices and conference room.
While the upgrading of clinics has helped in reducing congestion at UTH, Government, through the support of India with a US$50 million line of credit, has been constructing 650 health posts countrywide.
To date, out of the 650 sites, contractors have taken possession of 547 sites, representing coverage of 84 percent across the country.
Dr Chilufya told Parliament before its session ended that a total of 327 super structures have been completed countrywide, out of which 275 have been handed over to the Ministry of Health and are fully functional.
To further improve in its service delivery, the ministry this year launched the e-Health strategy 2017- 2021 aimed at helping improve provision of health services in the country.
Dr Chilufya says the country is investing in digital health and migrating digitally in the provision of effective and efficient health services.

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