Consent and confidentiality: challenges in HIV testing

 

A growing chorus of countries, NGOs
and foundations at the conference called for routine testing as an effective
strategy for HIV prevention. However, a number of panels and sessions at the
conference disagreed with this approach, suggesting that rights abuses related
to drives to scale up HIV testing can actually undermine AIDS prevention.

 

 

同意与保密：艾滋病化验中的挑战

 

越来越多的国家、非政府组织和基金会都一致呼吁将例行化验作为预防艾滋病的有效措施。但是大会上，许多专门小组和专项会议不同意这个方法，并指出，和急于扩大艾滋病病毒化验相关的权利侵犯，将破坏艾滋病的预防工作。

 

Most testing policies focus on the
benefits of testing and not on the potential risks. While UNAIDS advocates “The
Three C’s – Counseling, Confidentiality and Consent”, many national policies do
not include these as part of testing protocols.

 

In certain countries, HIV testing may be a precondition for marriage.  In her
conference presentation, researcher Katya Burns noted that in Bahrain, Guinea,
Malaysia and the United Arab Emirates, women who do not “pass the test” can be
beaten or expelled from the home.  While
such compulsory tests disproportionately affect women, they also promote a
false sense of security within the institution of marriage itself.

 

Lack of confidentiality can also
result in serious rights abuses that drive people underground and away from
treatment and prevention services.  In
many of the countries where the HIV epidemic is most strongly felt, there are
no data protection laws.  To address this
concern, the International Labour Organisation (ILO) adopted new guidelines
last month that specifically codify the right of confidentiality. However,
during those ILO negotiations, representatives from several developed countries
such as France, Germany and Austria opposed confidentiality provisions, arguing
that the HIV epidemic had been “imported” from other countries.

 

A draft bill in Uganda requires
mandatory HIV testing of pregnant women, drug users and sex workers, while also
allowing medical practitioners to disclose people’s status. Beatrice Were of the Uganda Network
on Law, Ethics & HIV/AIDS said, “This bill, unfortunately, is full of ineffective
approaches that violate human rights and will set us back in our efforts to
fight the AIDS epidemic and expand HIV programs nationwide.”

 

许多化验政策都只注意到化验的好处，而没有注意潜在的风险。联合国艾滋病规划署提倡”3C—-建议（Counseling）、保密（Confidentiality）和同意（Consent）”，但许多国家并没有将此作为化验规则的一部分。

 

在一些国家，艾滋病检测可能是婚姻的一个前提条件。研究员凯特雅·伯斯在她的会议陈述中提到，在巴林、几内亚、马来西亚和阿拉伯联合酋长国，没有通过检测的妇女会遭受痛打或者被逐出家门。尽管这些强制性的化验只是很不公正地针对妇女，但是它们给婚姻本身也带来一种错误的安全观念。

 

缺乏保密性也导致严重的侵权行为，如把人赶到地下使他们远离防治服务等。许多艾滋病肆虐的国度并没有信息保护的法律。为了强调对其的重视，国际劳工组织（ILO）上个月采取了新的规则，特别将保密权编入规则。但是，ILO在协商时，来自部分发达国家的代表，如法国、德国和奥地利的代表，反对这项保密权的提议，他们争论道艾滋病病毒是从他国”进口”的。

 

乌干达的一份草案要求孕期妇女、吸毒者和性工作者有履行艾滋病病毒化验的义务，同时也允许医师对病人的状态予以保密。乌干达法律地区和艾滋病联合工作处的比踹斯·沃尔指出：”很不幸的是，这项法律充满了违反人权的无效的方法，这使我们在与艾滋病抗战和向全国扩大艾滋病项目中走向倒退。”

 

Forced sterilization: Rights violations and a case study from Namibia

 

Several related conference sessions highlighted
the issue of the forced sterilization of HIV-positive women, including cases in
which women are tested for HIV without their knowledge or consent.

 

In Namibia, fifteen women are suing
their government, alleging that their forced sterilization in public hospitals
violated constitutional rights to dignity, to start a family, and to be free
from discrimination and inhuman and degrading treatment.

 

Two NGOs, the International Community
of Women Living with HIV/AIDS in Namibia (ICW-Namibia) and the Legal Assistance
Centre (LAC), have jointly documented
dozens of other cases where medical personnel performed sterilizations without
informed consent.  ICW-Namibia stated
that there was no medical basis for the practice, as the risk of
mother-to-child HIV transmission could be minimized through other means, such
as early diagnosis and ART.

In some cases, medical personnel obtained consent from women under duress.
Consent forms were cursorily signed while the women were in labor and on
their way to the delivery rooms.  In
other examples, HIV-positive women could not receive other medical procedure
such as abortions without agreeing to also be sterilized.

 

Motherhood is praised in many African
societies, and taking away the ability to give birth makes it more difficulty
for women to negotiate already difficult personal relationships, stated
ICW-Namibia.  Some women choose not to
inform their partners that they have been sterilized, for fear of retaliation.  Other women who did inform their partners
found themselves abandoned.

Other HIV-positive women have come
forward to sue the government over the forced sterilization practices.  However, Namibian Health Minister Ricahrd
Kamwi denied the existence of systemic forced sterilization.

 

强制绝育：侵权的行为以及一项来自纳米比亚的研究案例

 

几场相关的专门会议使得强制艾滋病呈阳性的妇女绝育这个议题成为关注，这个议题还包括妇女在不知情或不同意的情况下被进行艾滋病化验的情形。

 

在纳米比亚，十五名妇女对其政府发起诉讼，声称政府在公共医院推行强制绝育，违反了宪法的尊严权，组建家庭的权利以及远离歧视、非人道主义和侮辱性治疗的权利。

 

国际妇女与艾滋病生存协会纳米比亚分会（ICW-Namibia）和法律援助中心（LAC）这两家非政府组织，联合记录了几十个医务人员在未经患者同意对其进行绝育手术的案件。ICW-Namibia发表声明说，这种做法没有任何的医学根据，母婴传播的可能性可以通过例如早期诊断和反转录治疗法等其他方法实现最小化。

 

在一些案件中，医务人员通过强制获得了同意，协议书是在妇女临产或者去往产房时草率签下的。在其他案例中，艾滋病检测呈阳性的妇女如果不同意做绝育手术，就不能获得其他如流产等的医疗手术。

 

ICW-Namibia指出，母亲在非洲社会是受到赞扬的，夺去一个妇女生育的能力，使得妇女本已不易的人际关系更是雪上加霜。有些妇女选择了不告诉她们的伴侣她们已经绝育了，而另一些告诉了她们伴侣这一消息的妇女则发现自己被抛弃了。

 

其他艾滋病检测呈阳性的妇女选择了对政府强制绝育的行为进行起诉，然而，纳米比亚健康部部长里德·凯祢威否认了全局性强制绝育的存在。