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health or human rights?

21 July 2010
by

Today at the XVIII International AIDS Conference, I’ll present a poster of co-authored research about routine HIV testing at antenatal (aka prenatal) clinics in rural Malawi. For those unfamiliar, routine testing refers to HIV tests that are offered routinely as part of care; essentially, women are given an HIV test when they initiate prenatal care (though they are technically given the option to refuse that test and still access care). Our findings from rural Malawi are that most people perceive HIV testing a mandatory requirement in order to access care. The negative consequences of such a policy are the possibilities that women might forgo prenatal care if they do not want to take an HIV test. Though most thought HIV testing was mandatory, many in our study reported that was a “good” thing: good for the baby, good for the mom.

The research project makes me think a lot about this year’s conference theme: Rights Here, Right Now. Whereas the introduction of routine HIV testing has dramatically increased the number of women tested for HIV, its implementation in Malawi is in conflict with the Western notion of individual human rights, particularly that of choice/voluntariness. Some have retorted that the end justifies the means, but in this case, that’s not always true: women aren’t routinely given drugs to reduce the transmission of HIV to their babies before birth. In fact, in Malawi not every antenatal clinic stocks the drug used in prevention of mother-to-child transmission, not to mention the clinics where it is typically available experience stockouts or shortages.

I have heard a lot of people use the phrase “false dichotomies” at the conference (i.e., former US President Bill Clinton, current South African Health Minister Dr. Aaron Motsoaledi), but in this case, I think that there’s a real dichotomy pitting public health against human rights. Granted, there is some nuance and I don’t want to overdramatize the situation. Still, I think that what may be good for public health (testing routinely everyone who accesses health care) may not be good for human rights (requiring people to give you a bit of themselves in exchange for receiving something that should be universally available). And, in the end, if women choose to forgo care, we will lose out on the public health benefits of routine HIV testing.

You can read a pre-print of the paper here. My co-authors are Nicole Angotti and Lauren Gaydosh (yes, we all have a thing for funky, chunky eyeglasses). The manuscript has been accepted for publication in Health Policy and Planning.

For anyone at the conference, our poster is in the Track E section, #0887.

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