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Testing Times: AIDS ''not a disease of ignorance, it's a disease of denial''

Christina Scott

A ''deeply frustrated'' South African doctor's recent call for compulsory HIV
testing triggered intense debate and large audiences at the third South African AIDS conference in Durban. 

Dr Francois Venter of the respected Reproductive Health and HIV Research Unit in Johannesburg called for universal mandatory HIV testing in South Africa's Sunday Times newspaper in June.

Speaking in his personal capacity, Venter had argued that the level of denial was so intense that most of his patients only discovered their infection on their deathbed.

“It's dangerous to go this route,” responded Heidi van Rooyen of the Human
Sciences Research Council (HSRC). “Should we go back and undo twenty years of work with the possibility that it will fuel stigma and discrimination?''
“We shouldn't manipulate people for their own good, Francois,” chided Venter's colleague at the University of the Witwatersrand, philosophy and ethics professor Thad Metz. 

“When I saw his article, I screamed,” said Pholokgolo Ramothwala, who was tested for HIV/AIDS by his doctor in 1999. However, the AIDS Law Project fieldworker promised that he might support mandatory HIV testing if South Africa's ambitious efforts to slash the number of new infections in half by 2011 failed.

Ian Grubb of the World Health Organisation in Geneva, Switzerland, supported voluntary HIV/AIDS counsel1ing and testing but urged it to move out of hospitals or clinics and into shebeens and other people-friendly spaces. 

However, Grubb admitted the failure of existing testing systems, noting that in all of sub-Saharan Africa – the heart of the global epidemic - fewer than a dozen people out of every 100 know their AIDS status. “25 years on, HIV remains a hidden disease,'' Grubb said.

Seminar chairperson Fatima Hassan, an attorney with the AIDS Law Project in Cape Town, warned the audience not to throw tomatoes at Dr Venter when it was his time to respond.

But Venter leaned his arms on the podium and came out fighting. ''Our staff are dying of HIV/AIDS because they don't want to test. It's not a disease of ignorance, it is a disease of denial.'' He laughed at previous speakers who
argued that the voluntary system worked fine, simply requiring a bit more
refining, by asking if the next AIDS conference would see a doubling of the
percentage of South Africans who have tested. The number of South Africans who have tested for HIV/AIDS, after a quarter of a century of knowledge about the disease, currently languishes at about two out of every 100 people (2 percent).

And he tore into the bureaucratic terminology. “The fluffy language takes away the reality that people die of this disease. We have a culture of death.”

Venter then asked members of the audience if their insurance company forced them to take an HIV/AIDS test. Many hands went up. ''Lie number one is that it's voluntary in this country. For the rich, you get forced. I've had 12 tests. 11 were for insurance. Nobody is marching in the street demanding my right to get counselling.''

Lie number two, he said, was assuming that desperately ill patients were
volunteering to find out what was killing them. Another lie was the myth that testing had to wait until people were somehow ready for the results, which he compared to refusing to test a woman for pregnancy until the baby was coming out.

''The right not to know your status is not much of a right,'' he concluded. 

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