Should more people have AIDS tests in China to prevent and control the disease? A health expert and a charity head differ in their opinions.

Li Dun: Better ways to control spread of virus

Voluntary counseling and testing for HIV/AIDS in China is done according to the Regulation of AIDS Prevention and Control, issued by the State Council, the country's Cabinet.

Although the regulation says an HIV test should be voluntary, in reality disease prevention and control departments at all levels make people undergo compulsory tests for the human immunodeficiency virus. Before surgeries and medical investigations such as gastroscopy and enteroscopy, some hospitals always demand that the patient undergo a HIV/AIDS test, without which they will refuse treatment.

Moreover, in many provinces authorities have introduced compulsory blood screening for HIV/AIDS among the so-called high-risk groups (drug addicts, sex workers, homosexuals and professional blood donors).

The authorities should stop subjecting people to compulsory an HIV/AIDS test because it not only violates the Regulation of AIDS Prevention and Control, but also because it is against basic medical ethics. Since informed consent is an essential medical ethic followed by all medical workers, compulsory HIV/AIDS test should be prohibited in a society governed by the rule of law.

Compulsory HIV/AIDS tests do not work as well as some people think. Given China's huge population and the high mobility of people, it is impossible to implement large-scale compulsory blood screening for HIV/AIDS. At best, the authorities can keep track of only some people, not all of them.

Some people say a compulsory HIV/AIDS test before surgery or medical investigations help protect medical workers' against HIV/AIDS infection. In fact, everyone associated with providing medical treatment should abide by the principle of universal prevention, because medical workers are required to assume that all patients have the potential to transmit diseases. So, they should protect themselves against the transmission of any disease, not just HIV/AIDS. And they can do that by following medical rules and regulations strictly.

On the other hand, even compulsory HIV/AIDS tests cannot determine whether a person is HIV positive or not, because the human immunodeficiency virus cannot be detected during the window period, that is, between infection and manifestation. Therefore, the most important thing to do is to follow strict protective measures during medical services.

The authorities' attitude toward HIV/AIDS tests reflects the entire society's orientation. Disease prevention and control departments have no choice but to adopt compulsory measures when it comes to category "A" infectious diseases such as cholera and plague to control their spread and safeguard the public. But other blood-transmitted diseases, especially HIV/AIDS, can hardly be transmitted through common interpersonal contacts.

Though sexual contacts have been confirmed to be one of the three main sources of HIV/AIDS transmission, the chances of infection through unprotected homosexual contacts is 1 percent. The chances of contracting the disease are even less, 0.1 percent, through heterosexual contacts. To guard against contracting preventable diseases, we should protect ourselves rather than blame others for spreading them.

Some people are worried that potentially HIV positive people may hide their illness if we practice voluntary tests.

But the root of this problem lies in the lack of privacy for and discrimination against HIV positive patients.

The existing practice is to report HIV positive people as soon they are diagnosed with the virus to the national disease control network. But the medical history of such people can be easily leaked because there's no institutional restriction on keeping it secret. And once that happens, HIV positive patients have to face severe social discrimination.

It is this harsh reality that forces to avoid taking an HIV/AIDS test, even though it is good for them.

Under such circumstances, protecting HIV-positive patients' privacy and eliminating institutional discrimination against them may be a more effective way of preventing and controlling the disease than a compulsory HIV/AIDS test.

The disease prevention and control authorities should introduce a system to prevent insiders who have access to HIV positive people's medical information from leaking them and punish those who do. The authorities should also introduce a policy to prevent discrimination against HIV positive people in medical treatment and employment to set a positive example on the issue.

The author is a scholar in health issues. This is an excerpt of his interview with China Daily's Wang Yiqing.