Some large hospitals in Bombay insist that every patient seeking investigation or treatment should undergo tests to check for Human Immunodeficiency Virus (HIV).

This is done on the following grounds: (1.) In view of the known spread of this disease, it is essential to test every one presenting at the hospital for the patient’s own safety. If the test for HIV is positive, appropriate measures can be instituted in an attempt at preventing the development of AIDS. (2.) Hospital personnel must be protected against this disease which, at present, has no known therapy against it. This can only be done if each and every patient is tested. (3.) The data collected will facilitate epidemiological studies.

Problems posed by such insistence

1. All patients are forced to undergo a test, not performed gratis by the hospital, irrespective of their willingness to do so. There is, thus, an abrogation of the right of the patient to choose. The hospitals argue that an unwilling patient is free to seek investigation or therapy elsewhere. This, in effect, deprives the patient of his right to choose where he will seek advice and treatment.
2. No clear guideline exists on disclosure of the report when it is positive for HIV. The assumption that it will remain confidential is not borne out by the facts.
3. Should the test for HIV be positive, the patient and his family are ostracised by the hospital, doctors, nurses, other staff and society at large. In a recent instance in Bombay, a middle aged man, who tested positive for HIV, was accused by his own children of having indulged in promiscuous sexual intercourse out of wedlock. Untold agony followed till it was shown that he had probably contracted the disease from his wife who had been given contaminated blood as transfusions.
4. Should We, using the same principle, not test all patients for each of the variants of the hepatitis virus, the acid fast bacilli causing tuberculosis and leprosy, Treponema pallidum and other such infections?

A plea for sanity

Our collective behaviour at present resembles that in the recent past against persons with leprosy, tuberculosis and the venereal diseases. The almost hysterical attitudes adopted by individuals and groups who should know better against the person testing positive for HIV need imniediate correction.

Theres can be no argument against taking reasonable precautions to prevent transmission of AIDS from the patient to anyone else – doctor, nurse, other attendant, relatives or society at large. Simple, common sense measures against contamination are adequate. The virus is easily killed by a number of methods of sterilisation. Such as autoclaving and the use of disinfectants.

There is, however, no excuse for treating the patient as a pariah. This is against the ethos of a doctor.