Garth Rattray | Stop HIV testing for work medicals

I was drawn to The Gleaner editorial of Saturday January 3, ‘HIV treatment at crossroads’. It outlined and went into depth regarding Dr Richard Amenyah’s warning that “some of the global gains against the spread of HIV/AIDS could be in danger because of a cut in funding by the United States and countries for programmes to combat the disease”.

The editorial spoke to Dr Amenyah’s caution that, because of this recent US policy adjustment, there is an urgent need for Jamaica, and its Caribbean partners, to find ways to confront this danger through “sustained political commitment”.

Dr Amenyah is a respected international public health specialist. Up until recently, he was the director of the UNAIDS Multi-Country Office for the Caribbean. The UNAIDS (the Joint United Nations Programme on HIV/AIDS) is the primary worldwide authority on the HIV/AIDS epidemic. Its aim is to end the AIDS threat by 2030 by accomplishing zero new infections.

I vividly recall a time when we were totally helpless to stop or even slow the deterioration and inevitable death of patients infected with HIV. The antiretroviral drugs are medical miracles. Their improvement and availability (because of the USA) went a far way to increase patient adherence and, therefore, patient survival. Nowadays, people living with HIV /AIDS (PLWHA) who diligently take their daily medication, achieve undetectable levels of HIV, and live normal lives, since they will not transmit the virus or become sick because of it.

The invaluable US funding of the global partnership against HIV/AIDS greatly improved the health and lives of many people across the globe and [especially] throughout the Caribbean region. But, now that the funding for HIV/AIDS prevention and treatment programmes has been largely withdrawn, the ability to control that horrible disease will be diminished. Increased numbers of people will become infected, untreated, infectious, sick and die. To ameliorate this, Dr Amenyah called for “regional governments to increase domestic spending on fighting the disease, including fully integrating HIV/AIDS response in primary healthcare systems”.

COMPLACENCY

The editorial accurately pointed out that “Jamaica should work with regional partners to advocate for pooled procurement, regulatory alignment and fair pricing, ensuring that advances benefit people here”. Interestingly, the increased access to antiretroviral drugs led to some complacency in preventative measures and frequent (voluntary) testing where applicable. Given the current situation, we must get back to basics and double down on prevention – public messages (public education), primary care involvement, testing (knowing your status), and counselling.

I want to highlight the section of the editorial that spoke to the humongous problems with HIV control – stigmatisation and discrimination. It therefore concerns me greatly when I see the results from the mandatory pre-employment medicals that patients ask to be forwarded to me, and I see that HIV testing is still being done on some aspirants.

Doing compulsory HIV testing for job applicants reminds me of a time when the Ministry of Health used to require food handler’s permit applicants to do a blood test for syphilis. Everyone knows that syphilis cannot be transmitted when preparing or sharing food. When I asked why the syphilis test was mandatory, I was told that it remained on the books because the results were used for epidemiology. Eventually, when the Public Health (Food Handling) Regulations, 1998, took effect circa early 2000, no further syphilis testing was required.

When it comes to HIV, the virus cannot be transmitted by casual (workplace) contact. It cannot be passed on by hugging, sharing utensils, using toilets, sweat, tears, saliva, coughing, sneezing, urine, or even faeces. It can only be passed on by contaminated needles, vertical [mother to child] transmission, body fluids like blood, semen, vaginal/rectal fluids, and breast milk. None of these things are relevant to non-medical workplaces.

During the time when HIV was a killer, a daughter brought her mother to see me. Her mom was HIV-positive, deteriorating, and had a horrible, productive cough. Throughout the visit, her ill mother coughed and continuously showered me with droplets that I could feel. I had to sit there and remain unphased so that her family would see that her cough would not infect the household.

TREATABLE

Since HIV/AIDS is treatable, the US Embassy (and all other relevant US agencies) discontinued HIV testing as a prerequisite for permanent visa applications on January 4, 2010. Yet, some local employers still require HIV testing for job applicants.

Although the International Labour Organization (ILO) supports voluntary confidential counselling and HIV testing (because all workers should know their HIV status), it is totally opposed to mandatory HIV testing, questions regarding HIV status, and the revealing of any applicable medications for employment purposes, or for current employees.

Prying into the HIV status of a potential employee or a current employee negates confidentiality and is a prelude to stigmatisation and discrimination … the things that cause PLWHA to go underground, end up being untreated and spread the HIV virus. Nowadays, someone’s HIV status is no indication of that person’s fitness for work, danger to anyone on the job, or a financial liability to the employer. In forbidding mandatory HIV testing or HIV status inquiries in the workplace, the ILO is protecting people’s human rights and facilitating the integration of PLWHA into society.

Businesses and human resource departments should stop using the very antiquated pre-employment algorithm of requesting ‘routine’ HIV tests. Doctors and nurses should not succumb to the demands from workplaces to tick off the HIV test.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.