The Feasibility of Mandatory Testing
by: Hundera

Right before my green card interview, I was a nervous wreck, all because of a sealed envelope from an INS approved physician. Based on the results of this sealed envelope, which the immigration officer reviews, an HIV-positive result would have been grounds for denial of that cherished green light that would make or break my cherished lifestyle. Was a one-night stand in college, where God allowed the condom to break, going to forever punish me? Although we had been instructed about safe sex around the clock during orientation, and as if I had not brought that knowledge with me from before, in the heat of passion the Trojan must not have been saddled properly. But what was I to say to the immigration officer: "Please, you gotta understand; I made a mistake only once and only because it was not put on properly. I am a good citizen (or will be). I always use a condom." Unfortunately, no gray areas in the law and that would have been the end of it.

When I feared most that I may have been infected, there came many moments of anger. At myself, mostly. By no means was I ever a Casanova. Although I may have lost my virginity at fifteen, it was not until I was in college that I took up the sport again. Even then, my luck was such that most women I was interested in didn’t seem interested in me, or the few cases that wasn’t the case, their chastity belts might as well have been the type Woody Allen showed us in "Everything You Wanted to Know About Sex but Were Afraid to Ask." Save a few. And if I was infected and were going to die, the darkest element of my soul was further angered that I could not take out many others along the way.

And why the heck did I not get tested to find out before I saw the INS doctor to save myself the latent embarrassment? I must have given blood during numerous doctor visits, but never knew if they were testing for HIV. Never asked. lemin? yemimotibeten qen lemoqTer?

That test procedure has been puzzling public health officials for some time now. Who has the right to know about one’s infection? Must we inform the wife, or should we trust the husband to inform his wife? Often times, further treatment is suggested as a way to come to grips with the results. And eventually, it would be time to take those AZT pills (is this what is still given today?) so the wife will find out anyway, but the doctor will have long before recommended that the husband tell the wife. Anyway, what are the chances that the wife is not already infected? What’s the point of telling her that she also has about ten years left to live? What if the HIV diagnosed individual is not married? As is probably the case most of the time. Does the public health official have the right to inform the girlfriend, boyfriend or lover? Where does one draw the line over doctor/patient confidentiality in the pursuit of protecting the public’s health? Answers to these questions, from what I have been told, are widely divergent in the U.S. and in Ethiopia. Maybe someone else in this Seleda issue would have ended the conspiracy of silence regarding nondisclosure of results in Ethiopia, if indeed this is true.

A new approach seems to be underway. In Scotland, a man was recently imprisoned for having unprotected sex with a woman after he had been diagnosed with the virus, setting a legal precedent. Now, at least in Scotland, if you have tested positive and transmit the virus, according to the precedent, you are criminally liable. gud fela. This is far more radical than not telling the man that he was infected in the first place. But what is the consequence of this? Will more people, like me, who hesitate to be tested to begin with, likely go in if they know they cannot have unprotected sex anymore depending on the result.

At least, the answers seem clear to me, despite their heavy agency costs. First, tests need to be mandatory. The prisoner’s dilemma of whether to get tested or not on a voluntary basis would dissipate. You might be asking, "lEbaw min aT’efa?" Let me illustrate by example. Suppose, a husband and wife have been cheating and they both know it. They both know they could be infected but are not sure. If they both get tested, they will both know the answer and know how to handle the situation of the infidelity as it relates to their sexual practices. However, neither one knows what their test result will be. If the husband tests positive, the wife may divorce him, or vice versa. Nevertheless, if they both don’t get tested, they don’t have to worry about the real consequences other than minimal worries.

Now, if tests are mandatory, everyone will know the real results of their HIV status. Although we may not be able to force the husband or wife to inform each other, the doctor can act gently and insist on the best outcome. Furthermore, if, as in Scotland, we criminalized having unprotected sex by those who are infected, the mandatory clause would significantly decrease the infection rate. After the man’s imprisonment, many doctors went on record to say that they believed that people would not test voluntarily and that the infection rate would rise.

Well, even making it mandatory has its implementation costs, especially in countries that don’t have universal health coverage. Are the 40 million uninsured people living in America going to be forced to take AIDS tests? Somehow that does not make sense. I believe the tests should take place only if other services are offered. Therefore, universal health coverage seems to make sense in this case.

The astute may be asking questions about civil liberties and the effectiveness of mandatory testing. Should we not need protection of our personal health information? How do we make sure employers and insurance companies don’t use this information against us? Even if a test is mandatory, we should draw lines on this issue and forbid release of this information as we seal other medical information. The purpose is not to create hell for people who are HIV-positive, but to protect others whose lives people with HIV can ruin. So if the person knows s/he has HIV, s/he better not infect others. Furthermore HIV tests need not be expensive. According to a friend who gave me stock tips, Epitope is developing an HIV test contraption that costs less than $2 per test. So you may finally ask, if a person with HIV knows death is around the corner, how is prison going to be a deterrent. Honestly, I don’t know.

But when I went to my INS interview, I wish I had had the results beforehand. If the worst had come true, I would rather not have had the immigration officer break the news to me in front of my mother. But I sure am glad there was a happy ending here - at least to the green card chase.