Mandatory HIV testing: Public health vs Human rights

At the ongoing British HIV Association conference (BHIVA) taking place in Birmingham UK, a session on Late presenting of HIV highlights the characteristics of the epidemic in the UK raising the need for more community awareness amongst Men who have sex with Men (MSM) and people of African origin

Dr Valerie Delpech of the HPA in her presentation stated that as at the end of 2011, there are almost 120,000 people living with HIV in the UK, and that since the breakout of the epidemic 30 years ago, the UK has seen 20,000 AIDS related death and of the people living with HIV as at 2012, 25% of them are unaware that they have the virus. And these are mainly the population driving the epidemic. Furthermore, she started the epidemic is concentrated between MSM and African communities in the UK.

However, there is something that sets the African community aside from the MSM, and this is CD4 cell counts at the time of diagnosis. In the UK, African communities account for the highest number of late diagnosis of HIV. In this article, late diagnosis of HIV will be diagnosis of HIV at a CD4 cell count less than 350. This is because at this stage, the immune system (the cells that protect the body from disease attacks and they are the cell the virus needs to reproduce in the body) has weakened and do not have the power to fight the virus anymore.

Dr Valerie Delpech

At this stage of low CD4 cell counts, a person will start developing what is known as opportunistic infections and this will eventually leads to AIDS if not treated on time. The only treatment for HIV still remains Anti-HIV drugs.

In the UK we are seeing the rate of late diagnosis to be as high as 50%, however while more MSM are testing on time for HIV (Prompt testing), we are seeing an increase in late diagnosis amongst Heterosexual men from Africa. Of the 50% of people that presented late for HIV testing last year, 63% of them are heterosexual men of African origin. This data from HPA reaffirms the challenges African HIV charities are facing in the UK.

Age has also been identified as one of the key areas where there is an increasing rate of late diagnosis with 62% of people over 50 years diagnosed so far are diagnosed late.

Dr Marthin Fisher from the Royal Sussex Hospital Brighton raised the challenges of late diagnosis in relations to treatment adherence and effectiveness. He argued the later someone present for HIV the more difficult it is for the person to have better Quality of Care (QoC) and this will further reduce the chances of the individual to respond to treatment and even reduce their options for further treatment with new drugs.

Therefore the question is, should we offer mandatory HIV testing for everyone from high risk population? (When I say high risk, I am talking about the people that belong to the population with high rate of HIV epidemic MSM and Africans). If the answer to this question is yes, then how do we deal with the issue of fundamental human rights of an individual to say NO to HIV testing?

How do we make HIV testing attractive and easy to take up for people and most importantly for African heterosexual men? With the advent of better treatments that are prolonging life span of HIV positive people, it is not then a good public health issue to test people early and put them on treatment as soon as possible?

Dr Marthin Fisher

The other positive outlook to treating HIV early is that as we put people on treatment we reduce the transmission risk of HIV as seen in a study called HPTN 052. And this can only be possible if we test more people and put as many people in treatment as possible.

This is indeed an advocacy need of African communities in the UK but most importantly the need for African men to take the mantle of leadership in the fight against HIV and late diagnosis in the UK.

Though there will continue to be controversy over mandatory testing of HIV and fundamental human rights, but there is always a way out and one of it will be that everyone be offer routine HIV testing irrespective of race, gender or sexual orientation. Another important solution will be looking at the option of non conventional testing centers like community testing.

Finally we need to talk more about the advantages of testing for HIV and confront stigma and discrimination attached to HIV most especially within the African communities in the UK.