Systematic HIV screening in Cameroon, a dangerous initiative

On June 22 2016, the Ministry of Public Health of the Republic of Cameroon issued an information note on the new directives in the fight against HIV.

fight against HIV

According to the note, the goal is to improve care for people living with HIV and the directives fit into the implementation of an antitretroviral therapy Acceleration Plan. They are in line with international guidelines pertaining to the fight against HIV, including WHO’s new directives and UNAIDS 90 90 90 targets. Besides the creation of new care centers, the deployment of psychosocial workers, the subsidized price of biological follow-up examinations, the note requires the systematic screening of each and every person coming to a hospital for consultation, no matter the disease.

Forcing someone to be screened or screening someone without informing them is a coercive method and, therefore, a violation.

Here is an excerpt of the document entitled 90-90-90, An ambitious treatment target to help end the AIDS epidemic issued by UNAIDS: « The only way to achieve this ambitious target is through approaches grounded in principles of human rights, mutual respect and inclusion. Coercive approaches not only violate fundamental human rights norms, but they will also hamper hopes for ending the AIDS epidemic. As experience throughout the world has repeatedly and conclusively demonstrated, coercive approaches drive people away from the very services they need.« 

The information note is supposed to be in line with this document. However, the latter calls into question its validity. First of all, it is against Human Rights norms. Health is a private matter. Individuals should not be forced to know their serological status. Forcing someone to be screened or screening someone without informing them is a coercive method and, therefore, a violation. Furthermore, it undermines people’s trust in health workers.

People will stop going to hospitals, fearing they will be informed they have HIV. The setbacks in the health sector will be tremendous.

Second, inclusion is a key term nowadays. No programme, no plan can be a success without the inclusion of populations. Sensitisation instead of coercion. People need to understand the rationale behind a programme to fully participate in and benefit from it. If they feel brutalised either physically or morally, they will not participate. In this case, we are exposed to a major negative impact: people will stop going to hospitals, fearing they will be informed they have HIV.

The positive outcomes of all the good work and improvements in the health sector in Cameroon will be null. People will be more vulnerable to illnesses considered minor because they will not seek treatment from a hospital. Contagious diseases which are easily treated today such as tuberculosis will become a major problem because everyone will be exposed. Not to mention women in need of maternal care. It will not even be possible for health workers to treat people at home because they will not be trusted anymore. The setbacks will be tremendous, especially in remote areas where information are not well shared and rumours take precedence.

Sensitisation campaigns putting forward the benefits of knowing one’s serological status and the subsidized price of treatment will be a good way to attract people and achieve positive results.

When it comes to health, sensitisation about best practices is key. How is it that in Cameroon, a country with a good literacy rate, leaders feel the need to force people to do things for their own good? Sensitisation campaigns putting forward the benefits of knowing one’s serological status and the subsidized price of treatment will be a good way to attract people and achieve positive results.

An information note stating the systematic proposition of HIV screening to every person coming to a hospital for consultation was issued on January 25 (see @NMNjamnsi tweet below). According to Cameroon Tribune (June 27 issue), the Minister of Public Health said last Friday that the screening will be systematically proposed to patients, but the information note of June 22 says otherwise. Citizens are sharing information and thoughts on the topic on social media.

July 12, 2016 : The Cameroon Radio Television or CRTV, the national television channel, broadcasted a coverage during the 8 pm news broadcast on the new measures adopted to fight HIV. Screening will not be compulsory, but it will be systematically proposed to every patient coming to a hospital.

Photo: Health Map

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4 Commentaires

  1. For once, I have to admit, I don’t undersand the issue here. The service note here provided is an information document, therefore a public document which will be made visible in all hospitals concerned by this activity unless I am wrong. This means that people will be informed that the systematic test is done. Therefore, you have the right not to get treated in the said hospital.
    It is very easy for us to complain on the issue but I would say you may not have been personally touched close to you by the catastophy that HIV poses in our society and the irresponsible character of people.
    Indeed, though the treatment is now close to free, people still openly refuse to get tested, and even when tested and controlled positive, openly refuse to get treated. The highest treat to the high contamination level on HIV in our country is most importantly habits. I remember the initiative done in my former company proposing to people to get tested for free on 1st of December ,stats were so low while:
    1. So many people have sex without protection in Cameroon
    2. Very few people have the reflex of doing a basic « bilan de santé » each year and here this is everything but a question of means. Even those who can don’t do it.
    2. So many people (I don’t have the figures but they do exist) get re-infected on their HIV because not initially aware of their illnesses and even when aware maintaining hasardous behaviors.
    Seriously, I believe it is easy to complain on the government for this action but I would have wished to read in this article, what you propose alternatively to increase drastically the rate of open testing.
    One last point, people are encouraged/forced to test but their test are not revealed to anyone else but themselves. Based on the so many risks on the PERSONAL health that HIV poses when not identified, who is benefiting the most from this, government or population?
    As I said, happy to read the alternatives proposed and keen to understand how a publicly proposed test (though systematic) is a breach to human rights or to individual freedom.

    • My proposition is clearly stated in the text : sensitisation instead of coercion. Every coercive measure is a violation. Instead of forcing people to do things, it would be better to help them understand what the problem is and how they should act to curb it instead of applying coercive measures. Each and every time people were forced to do something, either good or bad, the result were far from being the best.

  2. I totally agree with you: forcing people to undergo a screening test will be dangerous and counterproductive. On the other hand, if – as some people explained on twitter – the doctors are just to propose the test without forcing the patients to do it, then they need to put more emphasis on sensitisation. Because at the end, those who are afraid to do the test will never accept the doctor’s suggestion. As you rightly sait it, « No programme, no plan can be a success without the inclusion of populations. Sensitisation instead of coercion ».

    Thanks for this excellent article.

    • That’s the thing actually. The Minister should clarify the situation: doubting is even more harmful because rumours are starting to be spread.

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