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Saturday, April 19, 2014

Voluntary HIV Testing in Schools: Ethical Perspective

The Minister of Health in South Africa has indicated a move in the country towards mass testing of populations as a strategy towards HIV prevention.[1] A voluntary testing programme is to be implemented, first at universities and later at schools. The next phase will be testing workers on farms and mines and in industrial areas. Expanding HCT campaigns to schools raises several ethical issues, the most important of which relate to privacy, confidentiality and voluntary participation.
In the school situation, learner's reactions will be watched by their peers and educators.Deciding to be tested will quite possibly not be a private issue.It might be quite noticeable who gets tested and who doesn't. Reasons for not being tested could be that the person already knows their status, or is a virgin and feels that he or she knows his/her status without being tested, or perhaps a person doesn't want to be tested for fear of the result being positive. Whether there will be sufficient privacy for the decision to be made without others making inferences is a moot point.
Schools of course are notorious for the power and authority issues which arise between those in “authority” (principals, teachers, prefects, bullies, selection committees for future prefects, etc) and learners. Whether HCT will be able to be completely voluntarily (i.e. no coercion taking place) in the school situation is debatable and the possibility of discrimination against those who don't choose to be tested is a real possibility.
Confidentiality will be a major issue and post test counselling is often of necessity much longer for those with a positive result than those with a negative result. This will in a sense be measurable by the rest of the class/school. “So and so’s post test counselling was much longer than mine, so she must be positive” is a strong possibility. Add to this the fact that someone who is diagnosed positive will in all likelihood be extremely traumatised and upset and one wonders if confidentiality in the school setting is at all possible.
A further ethical issue could be in the area of consent to being tested. Parents may have different desires to their children regarding testing. The final decision must rest with the child.
Another ethical consideration is that HCT should only be carried out if there is provision for treatment for everyone who tests positive.
None of the above mentioned issues should detract from HCT campaigns in schools, but should rather stress the importance of bringing teachers and learners and parents on board before the campaign kicks off to try and lay a foundation that safeguards against stigma and discrimination and ensures that none of the rights enshrined in the constitution are violated.

[1] Health Minister intensifies fight against AIDS- The Times, February 14, 2011

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