Counselling before an HIV test discourages people from testing and is a barrier to AIDS treatment, according to one of the South Africa’s leading AIDS activists.

In a provocative address to University of KwaZulu-Natal (UKZN) students on the 4th of May, openly gay High Court Judge Edwin Cameron said that extensive pre-test counselling had been appropriate in an era where there was no treatment for AIDS and HIV positive people faced little but discrimination.

“But we now have a mass epidemic where mass treatment is also possible, so extensive pre-test counselling may be a luxury we can no longer afford if we are to reach everyone who needs treatment,” said Cameron.

Health workers should be able to routinely test patients for HIV in places where AIDS treatment was available, there was no discrimination and patients’ HIV status was kept confidential, said Cameron.

“When a person is suspected of having breast cancer, their doctor does not have to counsel them extensively before testing them for cancer,” said Cameron.

Before AIDS treatment had become widely available, human rights activists had “exceptionalised AIDS”, he said. Extensive counselling was one of the protective measures “designed in a world where an HIV diagnosis meant discrimination”.

“The challenge we now face is to normalise AIDS treatment,” said Cameron. “Where treatment is available, exceptionalising AIDS impedes treatment. There is no reason why AIDS should be treated differently from breast cancer or any other disease.”

In Botswana, where antiretroviral treatment has been freely available since 2003, HIV tests without counselling are routine at clinics and hospitals unless a patient refuses to have a test.

Cameron was speaking at a memorial meeting for UKZN law lecturer Ronald Louw, who died almost a year ago of AIDS.

Describing Louw as an “eloquent, informed, AIDS-literate man”, Cameron said he believed Louw was too afraid to take an HIV test until it was too late because of a sense of “inner shame”.

Louw was diagnosed with HIV when he was admitted to hospital less than a month before his death. This was despite the fact that friends concerned about his health had asked him to go for an HIV test some two years before his death.

“Ronald died of a paralysing dread of confronting HIV. He was unable to take constructive action to seek life-saving treatment because he lacked internal self-acceptance,” said Cameron.

Cameron added that he had also visited St Mary’s Hospital outside Durban, yesterday. Despite the fact that the hospital had a renowned AIDS clinic, staff were dying of AIDS because they were too afraid to get tested, he said.

“Internal self-acceptance [of AIDS] has nothing to do with educational levels or sophistication. It is an emotional, human thing. Pre-test counselling may feed into the internal stigma and mean that people who need treatment refuse to be tested.”

By Kerry Cullinan

Health-e News Service

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