Human Rights and HIV

Police-initiated testing? Let’s return to the rights-based approach!

by Melissa Ditmore

I’m sorry to be the bad fairy while most people feel good about our achievements on World AIDS Day. Sex workers in Mongolia and Macedonia have reported being forced to undergo HIV testing subsequent to being arrested. Sex workers are rightly indignant: forced testing is a human rights violation and has been condemned by the World Health Organization and UNAIDS.

Sex workers are concerned because last week, The Lancet published a study suggesting that early treatment for HIV may decrease HIV transmission. More research is necessary before this is acted upon, but early treatment requires being tested for HIV and having access to ARV medicines for HIV. Mass testing would be necessary before mass treatment can occur in order to determine to whom to give ARVs. However, mass testing is a very difficult undertaking, as demonstrated by the experiences of sex workers forcibly tested.

Lesotho recently tried to implement HIV testing on a mass scale, and Human Rights Watch documented many pitfalls, problems and rights violations. Human Rights Watch and ARASA found that the campaign did not provide appropriate training and supervision for counselors conducting the testing, undermining the quality of the services provided, and that it did not adequately link HIV testing to follow-up prevention and treatment services. This presents problems for sensitivity and access to ARVs for those who may need them.

International bodies like WHO and UNAIDS have discussed provider-initiated testing, which should mean that a health care provider discusses the benefits and risks of testing for HIV and offers the test with appropriate counseling. Voluntary counseling and testing has not taken off in places where confidentiality may be compromised; this is one reason for the push toward provider-initiated testing. But sex workers rightfully question whether this will mean ‘police-initiated testing’ as experienced by in Mongolia and Macedonia.

Jonathan Mann promoted a rights-based approach to HIV-programming, which should not be abandoned for anyone least of all the most vulnerable people in our societies, including some sex workers.

Melissa Ditmore, Ph.D.
Sex Workers Project
Urban Justice Center