Outrage as Zambia moves to mandatory HIV testing

The President of Zambia, Edgar Lungu, announced last week (15 August) that the country would start implementing mandatory testing for HIV among all patients admitted to a public health facility – a move that was highly criticised by members of civil society.

The news was announced on the inaugural HIV Testing, Counselling and Treatment Day in Lusaka, Zambia, which replaced the annual Voluntary Counselling and Testing Day, commemorated between 2006 and 2016.

President Lungu later reiterated the point on twitter.

In Zambia, some 67.3% of people living with HIV report knowing their status. Mandatory HIV testing is being implemented to ‘fast-track’ the elimination of HIV in the country by ensuring as many people as possible get tested according to government officials.

But for those working in health, compulsory HIV testing is widely considered unethical and a violation of a person’s rights, as individuals should be ready to learn their status and not feel pressured into having a test.

Compulsory HIV testing is not supported by either UNAIDS or the World Health Organization (WHO), except for the screening of donated blood, organs or other bodily tissues.

Mandatory testing is also considered counterproductive in its aim to get more people learning their status, as it only serves to drive more people away from vital health services – particularly those groups who may already feel marginalised or stigmatised and who may be most at-risk.

Enrique Restoy of the International HIV/AIDS Alliance said: “We believe that everyone has the right to know their HIV status, to access HIV prevention, treatment, care and support, and to not be discriminated against based on their HIV status. However, mandatory HIV testing is ineffective for preventing the spread of HIV and it is crucial that any testing, counselling and treatment must be done voluntarily, with the informed consent of the patient.”

Engwase Mwale, Executive Director of Non-Governmental Organisations Coordinating Council (NGOCC) said, “As much as it is Government’s responsibility to ensure a healthy nation, such a pronouncement [mandatory HIV testing] does little in respecting citizen’s individual rights especially to privacy which are guaranteed in the Constitution.”

AVERT CEO, Sarah Hand, also stated. “These types of statements are often born out of an agenda of frustration with regards to a lack of progress towards ‘the first 90’ – but mandatory testing is a knee-jerk and untenable reaction that will not bring about the necessary change, or build upon what Zambia is already achieving.”

Since the announcement, there has been some confusion as to the terms of the new policy – with the Minister of Health, Dr Chitalu Chilufya, remarking that patients could opt-out if they did not want to test. But the Chief Government Spokesperson, Kampamba Mulenga, later told the BBC that mandatory testing would be put in place. It remains to be seen how the government will enforce the new policy.