I have a problem with forced and mandated HIV testing in Africa, simply, because of the swiftness in deploying punitive other than purgative due diligence.
This has ramifying effects including inciting animosity in the public in case of unguarded media reporting. Once HIV testing is used to generate court evidence, the legal execution has its mode of operation and any hinderance is easily construed as obstruction of justice which in itself is culpable. When the legal churning wheels turn, it is hard to pluck out the person around whom they turn. Legal handling bumps off the core beneficial health aspects (health care due diligence) inherent in HIV testing. In this situation testing (which may easily be done without counselling) is used to generate court evidence. Not only does this raise an animus toward the health corp but it depicts them as accomplices in the criminalization agenda. An HIV+ve suspicion or history binds one to a criminalized path which assumes one guilty even before one is judged so by courts of law.
When testing is used to generate court evidence, the full force of the law including: security; a quick route to incarceration; bail issues; fees for defense lawyers; media spins and social stigma come into play. The person undergoing the testing is characterized as an undesirable. A repertoire of dehumanizing and esteem depriving contexts are added to the unfolding drama. This sets in psychological trauma for the individual. It remains for all to ask if this psychological trauma is addressed along the way.
HIV testing is utilitarian, beneficial and is part of other domains including: commitment to HIV prevention practices; access to information, education and communication; enabling environment for participating in post-test club activities; access to prevention consumables which means friendly providers and consumables used for oral, vaginal and anal sex; linkage to ARV therapy, PrEP or PEP; empowering sexually active persons with safer sex decision support information, education, communication and peer-to-peer trainings; domestic level negotiated safer sex practices. This is what constitutes the purgative due diligence.
HIV testing is part of different service interventions which in turn are a standard of care at: clinical; psychosocial; personal; and collaboration levels. Political or high position figures in Africa are instrumental in the fight to end HIV. But, they can stoke the fires of criminalization by their statements whether in jest or otherwise. For instance: “as we test for malaria, we don’t consult you to consent whether you should be tested for malaria or not, we will do the same with HIV and AIDS” by President of Zambia. We miss out on the etiology of what informs transmission of HIV in many of the situations on the African continent. We instead, pursue HIV both as an opportunity and motive to prosecute. Lavrentiy Beria, the head of the KGB, said to Stalin: “Show me the man, and I will find you the crime.” We shouldn't be criminalizing HIV. In doing so, we create simple situations in which the criminal justice is used to manufacture and tailor-make crimes to fit a particular person.
In my experience,I have met sexually active bisexual youths whose knowledge about HIV transmission is that anal sex is not a transmission route. I have also come across situations where older persons make voluntary choices for younger sexual partners under the assumption that this context the younger partner is seronegative. Four issues arise from this: the need for messaging around serosorting; risks of unprotected sexual intercourse; sexual intercourse outside marriage; and developing prevention messages around oral, vaginal and anal sex (co-sexual practices).
In the case of Africa, wouldn’t it be prudent and imperative to tailor messaging and services to address lived sexual realities? Institutions affirm heterosexual sexual reproduction and sexual intercourse in contexts where consenting married partners. They negate all other forms. This is restrictive and not realistic. There is need to redesign action if Africa is to reverse HIV.
It is understandable there are many who are frustrated by HIV. But, this will not wish it away. Eradicating HIV is a product of examining and addressing structural barriers e.g. at social, cultural, political and cognitive-psychological levels that impede real world progress. Africa needs to look back at the The Second Durban Declaration: Access Equity Rights-Now!
Focussing on the five key scientific advances
- Ensure access to antiretroviral therapy for all people living with HIV
- Scale up modern combination HIV prevention packages
- Treat and manage coinfections and comorbidities
- Amplify research efforts for a vaccine and a cure
- Optimize implementation research
Addressing the five key structural barriers
- Focus on key populations within and across various HIV epidemic scenarios
- Address gender inequality and empower young women and girls
- Challenge laws, policies and practices that stigmatize and discriminate against people living with HIV and key populations
- Increase investment in civil society and community lead responses
- Enhance capacity of frontline healthcare workers
Tom Muyunga-Mukasa is President and Co-founder of the Rainbow Networks Africa (RANA). Muyunga-Mukasa is a Harvard trained Global health specialist. He is an iteration and design formulator around sexuality, orientation, gender, identity, health and development (SOGIHED) for grassroots. He has used the vast networks he helped create to start and maintain conversations around HIV Laws and Gender expansive issues in Africa. He is a competency and compliance facilitator for communities or individuals engaged in problem-solving in situations at the interface of law, normalization and conflict (LNC). As a facilitator he leads teams in creating change that entrenches inclusion. As a health advocate, he catalyzes the ownership by individuals health seeking practices. As a writer and editor, he has developed narrative that empowers communities to use the potential of silence to attract audiences.