The Zambian Observer

Depending on donor funds for mandatory HIV testing is dangerous, warns Dr Manase Phiri

Dr Manase Phiri

Renowned HIV activist Dr Manasse Phiri says as government embarks on an ambitious path of testing everyone and putting those with HIV on ART treatment, there is need to look for domestic sources of funding so that it can be sustained once donors pull out.

And Dr Phiri says President Edgar Lungu cannot close debate about mandatory HIV testing because there is need for further clarifications.

Meanwhile, Dr Phiri says it is highly discriminatory to make statements that no one has the right to take someone else’s life by infecting them with HIV.

Speaking when he phoned in during 5FM’s ‘The Burning Issue’ program yesterday, Dr Phiri observed that the money used for testing and treating HIV was all from donors.

“We have so many other things that we need to sort out, this political leadership in our country, they say they want to know the exact people who are positive so we can put them on treatment. That money for treatment, that money for testing is not our money. What if Donald Trump says ‘no more HIV money to Zambia’ where will people go? What are we going to do? So alongside what we are talking about, we need to be talking about domestic financing, how are we going to raise money so that we are able to pay for every Zambian who is on treatment? It must be now. We don’t talk about HIV in our prisons, we don’t even allow condoms in prisons. What about adolescent reproductive health? We have 16,000 girls getting out of school because they are pregnant, how many of those are catching HIV? It is a calamity for the nation but we don’t seem to worry as a nation, we just keep debating about compulsory,” Dr Phiri said.

And Dr Phiri said there was need for more debates on the mandatory testing policy because there were many unanswered questions.

“And what I am hearing about this mandatory testing, or compulsory testing now by the Minister and by other people is that we are talking about routine testing, and that I support totally. Mandatory testing, compulsory testing is almost punitive and the Doctors there describes to you what happens in some countries. Just by being somebody from Zambia, from Africa, you can’t enter the country, if it is positive, they will not allow you to go to Australia because it is mandatory, it is compulsory testing,” Dr Phiri said.

“But where the President said ‘this is it and no debate’ and here we are debating. I mean he couldn’t close the chapter like that and it’s better if it needed clarification and if indeed people wanted to take him to court, they could have and they still can if he is insisting that this is mandatory testing where police are going to wait by the door if you refuse to test, they push you in, it means you have committed a crime. There are people who were getting ready to seek court action because it sounded punitive; it sounded like a punishment for people who were going to refuse to test.”

Meanwhile, Dr Phiri said it was discriminatory to state that no one had the right to take someone else’s life by infecting them with HIV.

“But what am hearing, what we are talking about now is routine testing and we need to make that very clear because as the Dr says, it has that option that if somebody doesn’t want to be tested, they can say so but with guidelines from the government or from the Ministry of what then do we do with that person because of the way it has gone out to the public and social media of a person who is being bundled by police because he apparently refused to test,” he said.

“So what will happen to people if they refuse to test if indeed it’s mandatory? And I think we need to get clarification on this. We don’t need to be emotional about this, we need to sit as a country together ourselves as activists and pure doctors and politicians who are making these pronouncements, we need to be sure that we are all speaking the same language. I have worked in HIV since the very early 1980s and I am yet to meet one person who is proud to be HIV positive, who deliberately becomes infected, it’s something that is dreaded. So we must stop stigmatizing and discriminating by saying nobody has the right to infect anybody, nobody has the right to kill. We know that already and even the people with HIV know that.”

He also said President Edgar Lungu should have led by example by publicly testing for HIV after the launch instead of his team only flashing pictures where he was checking his blood pressure levels.

“It [the mandatory testing pronouncement] does [make me happy] in a small way. It is the first time that a Head of State has made a pronouncement regarding how we are going to deal with this epidemic from that level but unfortunately, the leadership in leading by example did not happen. I was so amazed that the pictures that were on social media, in our newspapers were of the President having his blood pressure checked, he wasn’t launching a blood pressure problem. He was launching a testing and counseling and treatment program. How much impact would it have had if he had tested with whoever in his Cabinet there?” Dr Phiri asked.

He also warned that counselors could not be trusted to maintain confidentiality like doctors.

“The way we have been testing for HIV, the people in the frontlines are not doctors, the majority of them are lay counselors so they may not be as bound by medical ethics as we would like and it is something that we should bear in mind. If we are going to go in this new way, who will be in the front lines? Will it be doctors or nurses or are we still going to use counselors who are going to say ‘look, you have tested positive now I am going to connect you to treatment’,” he said.

Dr Phiri further said there was need for innovative ways of persuading more men to test for HIV.

“And also, this confusion, why we are talking about this, I think it is a nomenclature; mandatory vs compulsory vs routine. What my good president of the ZMA has been describing is routine testing with an option to opt out. And it didn’t always happen, the idea was if a woman becomes pregnant and comes to the antenatal clinic and they are going to take blood from her for all the other tests that we do, they will take for HIV as well unless she said ‘no, I don’t want this’. So she gives consent and as it was explained that yes it has worked wonderfully,” said Dr Phiri.

“Men don’t go for testing, they don’t go for medical examinations, men are culprits. Even when they are tested and are put on treatment, more men are dying because they are not complying with the treatment. So what we need are innovative ways of persuading more men to test, of fining men in places where they are and where they feel it is safe to test them rather than anybody coming to the clinic to be tested, we are not going to win this battle like that.”