The issue of mandatory HIV testing has been playing around in my mind for quite a while now. As if that isn't the understatement of the year, the idea has not gone down well with the Swazi government either. Their take on the ethical issues associated with this is valid, in my books, but who's to say there are no working solutions to get over this? I think we as a nation are far beyond the point where we can debate whether testing is ethical or not. At the rate that things are going, we may as well just go extinct! HIV is just what it is, its a micro retro virus that can't even kill you on its own! How can such an organism be destroying a whole nation? If cancer and other non-communicable, but just as chronic, diseases are on their way to be under control in other countries (ahem, USA), how are we honestly letting HIV get the better of us? Why are we still declining proposals to mandate HIV testing? First let's evaluate the severity of the HIV problem on a personal/household, community, and national level.
1. Young adults, especially women, still want to be "cool". We still want to be known for who we are sleeping with and how much money they make. We still want to be seen in flashy cars and fancy hotels, adhere to fine dining and "live the life". Excuse me, what happened to school? What happened to independence? We all know the sugar daddies (and arguably, mommies, though that is just a hilarious visual if you ask me) have no interest in you beyond what you can offer them physically. Thats problem number 1 -- our priorities are as messed up as messed up can be defined.
2. Even though HIV infection has gotten to the rate of almost 40% in adults, we still find this topic very taboo. I love my culture, I respect it with utmost sincerity, but that does not mean Im an idiot when it comes to analyzing it as well. How can half the nations most productive and reproductive people be in danger of dying and we are still afraid to talk about it? We are afraid to test. The government has made us afraid. Our society keeps us in a tight eggshell bubble that we can't escape even if we tried. U test, then what? What resources are available to you? You can't even go to the supermarket without the neighbors rushing to avoid bumping into you. This topic is so taboo that people are afraid of losing too much weight, or even saying they are sick with the flu. Soooo taboo that the newspapers' orbituary section, growing at the rate of 3 pages a month, choose to specify "minor accident" rather than "undisclosed illness" or worse yet, "HIV/AIDS related symptoms" (I want to live to see the day...). If we don't know what is going on around us, we can't help ourselves, if we can't help ourselves, we can't help others.
3. Investment is going down, down, down. The more people get sick and can't work, the less motivation businesses have, to stay in the country and keep it booming. This goes for private investors and for government franchise. No money is coming into the economy, meaning we have less to support those who are sick, or worse still, those who are not sick and want to continue working. Those who are not sick are not getting jobs, so they will ultimately turn to "trying to live the good life", and get sick. Those who are sick will get worse due to inefficient health care, and die from the bite of a mosquito or a mere cough. Who do we leave behind? The young orphans that are born into an unstable world in a vicious cycle of HIV-Economy downfall, they aren't encouraged to be better, to be different.
In my opinion, mandatory testing becomes an issue when you force people to test for HIV and then dump them with the knowledge, sans resources to help them live better with the sickness, and to help and encourage those who are still HIV-free (yes, all 3 of us). Ultimately, we can't force a nation to go out on a particular day and test for HIV. But, we can still go about it in a systemic way (Please forgive our health minister, who is a Form 3 dropout and may not be at liberty to make informed judgment). For one, rumour has it, Swaziland is starting a free primary education for all programme starting a year from now. I think that is the perfect platform. Free primary education not only means we can all finally reach secondary level now (even the ministers to-be), each one of us will have access to a school, regardless of where they come from. If we are now offering free primary ed, what is wrong with mandating an hiv test as a requirement to get into the school?
Of course, we wont just stay there, we can then provide the education and resources for all those who test positive. We already have organizations like the Family Life, PSI, the Baylor Clinic, among others who provide free testing and support. ARVs are now (i am excited about this) distributed via NERCHA and not the ministry of health (who, for years on end, ran out of supplies because they could not manage the in-flow very well). It takes one committee to do this. Get all these organizations together and say, ok. Lets strategize a plan to help those kids who are coming into this free program (hopefully, all kids) by providing them with the drugs they need, the motivation they need, and the comfort they require. It might be dangerous to alienate them and put them in their own "classrooms with special speeches", but I certainly think there is a way to incorporate awareness and empowerment among all students, regardless of their HIV status.
The bottom line is I am tired of inefficient governments who refuse to even TRY, in the name of ethics. Are we really still debating ethics? HIV is not being ethical about who it kills and who it doesn't. It certainly isnt being ethical about our economy either.
So if you ask me, to test or not to test?