'Real-name' HIV/Aids tests a huge risk, say medics
Experts agree that greater adoption of voluntary counselling and testing (VCT) programmes is vital in tackling the HIV/Aids epidemic. But a push by mainland authorities to demand real-name registration for such services has put rights activists on a collision course with medical workers.
Guangxi is leading the push, with the autonomous region's People's Congress considering a controversial draft regulation to force those seeking counselling and testing to identify themselves at government test centres.
It also stipulates that those who test positive should tell their spouses or partners within 30 days, with the test centres being authorised to do so on their behalf if they fail to comply.
The director of the Chinese Centre for Disease Control and Prevention (CDC), Wang Yu , told a media briefing this month that he supports the regional regulation and that it could become national policy.
He argued that anonymity in voluntary counselling and testing programmes put people at greater risk. 'The stigma associated with those with HIV/Aids should be removed via other pro-active measures,' he said.
But rights campaigners from grass-roots non-government organisations (NGOs) greeted Wang's remarks with scepticism, saying they fear a public health catastrophe if such a requirement is put in place.
Ye Chengjiang , a project manager at the Guangzhou office of the Chi Heng Foundation who works on HIV/Aids prevention among homosexual men, said that a real-name requirement for voluntary counselling and testing ran contrary to the intent behind such programmes, which was to boost prevention by increasing uptake of testing services and cultivating higher public awareness.
He said those seeking tests at present do not need to sign up with their real names for first-time testing and that his office was among several grass-roots NGOs in Guangzhou enlisted by government test centres to help reach out to target groups.
'I have serious concerns that such a requirement would simply scare people away because it will break the trust we've worked so hard to build ... over the years,' Ye said.
In Hong Kong those seeking counselling and tests can arrange them anonymously by calling the Department of Health's Aids Unit. Registration is only needed when those who test positive seek treatment at specialist clinics elsewhere.
Wan Yanhai , from the mainland rights advocacy group the Beijing Aizhixing Institute, said the real-name requirement was part of an ongoing official crackdown motivated by a desire to maintain social stability. In a speech at a national conference on social stability in November, Zhou Yongkang , a member of the Communist Party's Politburo Standing Committee, said those with HIV/Aids were targets for 'social management' to 'resolutely stop the spread of the disease'.
In an online appeal against the real-name push, however, Asia Catalyst, an NGO advocating the rights of marginalised groups in East and Southeast Asia, urged the mainland authorities to learn from the mistakes made by other countries - from initial denials to the havoc wrought on public health programmes by stigmatising and discriminating against those with HIV/Aids.
'Many countries have learned the hard way that voluntary testing, confidentiality and strong legal protections against discrimination must be part of any successful policy response to the epidemic,' it said.
A joint survey by the Joint United Nations Programme on HIV/Aids (UNAIDS), the family planning organisation Marie Stopes International and the Central Party School's Institute of Social Development Research - in which 2,096 people with HIV/Aids in 25 mainland regions were interviewed between 2008 and 2009 - found that 83 per cent chose to relocate after testing positive. Forty-one per cent said they experienced discrimination at work, 33 per cent were denied promotions and 13.3 per cent they had lost or been denied jobs because of their HIV status.
The mainland's office of UNAIDS said it advocates the greater adoption of rapid testing because if results and ensuing counselling could be provided almost immediately, people would understand the disease better and seek further treatment.
'It is important that government take concrete action to address stigma and discrimination in all settings,' it said. 'Steps need to be taken to revise all discriminatory laws and policies, such as the guidelines preventing people living with HIV from serving as civil servants.'
UNAIDS warned that if confidentiality protections were not in place, there was a real risk that people would simply avoid getting tested, removing the opportunity to provide treatment to those who need it and making the work of prevention, treatment and care services more difficult.
Citing a one-month-long trial of a real-name testing regime at the Rainbow Clinic, a voluntary counselling and testing centre in Beijing, last summer, UNAIDS said that 128 of the 351 people seeking tests refused to undergo real-name testing.
The mainland has 346,000 registered HIV carriers and Aids patients, but the actual number was expected to hit 780,000 by the end of last year, according to a joint assessment by the Ministry of Health, the World Health Organisation and UNAIDS.
About 56 per cent of those infected are unaware of their condition and between 30 million and 50 million people on the mainland are at risk of infection, according UN agencies working on HIV/Aids prevention.
Lu Hongzhou , a renowned HIV/Aids specialist in Shanghai, said the real-name requirement had a number of benefits.
'For patients, they could be followed up with counselling and timely treatment and from the public health point of view, such a requirement will facilitate treatment for existing Aids patients, which reduces the chance of new infections,' Lu said.
He said that most of the 28,000 mainland Aids patients who died last year did so as a result of delayed treatment and that people should not worry about privacy breaches because those conducting the tests had to abide by strict guidelines.
But Professor Gao Yanning , who researches HIV/Aids at Shanghai's Fudan University, said he shared the serious concerns of marginalised groups about the new requirement as privacy safeguards on the mainland were insufficient.
He said those in favour of such a requirement could also come up with many justifications for it, which made broader public consultation essential for such a policy to work.
'The problem is that the government CDCs might not want to consult other groups given that they have been bullying [others] with their near monopoly over VCT on the mainland,' he said.