Tags:
Journalism of Courage
It is ironic that while the World Bank has sanctioned lakhs of dollars to the Maharashtra Government to spread the information about AIDS in India, the person who is at a direct risk, the sexual partner, has no right to the vital information that may save his or her life. Says Dr Sanjay Pujari who treats HIV positive cases at Ruby Hall Clinic: 8220;The highest risk activity an Indian woman can do today is to have sex with her own husband because in my own experience 90 per cent of the HIV positive women have been infected by their own husbands.8221; This raises the question of partner notification. In India, all patients especially HIV positives, are protected by the Confidentiality Act where a doctor cannot reveal the HIV status to anyone without the patient8217;s permission.
But should an AIDS patient be protected by this Act if this very confidentiality can take the life of another? Given the AIDS issue, the whole scenario has changed, because keeping this vital information can take the life of another, as in the case of Bharati, a 24-year-old from Pune who married Ganpat four years ago. Ganpat was HIV positive and deliberately kept this information from his wife. 8220;The doctor wanted to meet my husband because I had a genital rash which was not healing. My husband kept refusing to meet my doctor and kept saying he was seeing another doctor. Later, when I got pregnant and had to abort my baby at four months I realised that I had AIDS. I lost my baby and now I myself am a full blown case of AIDS,8221; says Bharati, who is emaciated and is battling with tuberculosis at a Government Hospital in Pune.
So, should doctors be allowed to pass on the HIV status to a spouse if so asked? Or should the patient enjoy the doctor8217;s confidentiality?
Pujari, despite believing that Indian wives are at a high risk by having sex with their own husbands, says that HIV positives should enjoy a doctor8217;s confidentiality.8220;In spite of this, I feel that the patient8217;s confidentiality should be maintained. This is because AIDS cannot be seen as a partner notification issue alone. It has many issues related to it and the most important factor in the control of AIDS is counselling and the basic premise in counselling is the security of anonymity.8221;
According to Dr Dilip Shah: 8220;It is all very well to say that a sexual partner has the right to know the HIV status, but then if I as a counsellor pass on this information to another person, what support system do I have to offer him? I can8217;t just tell his wife and leave it at that. This way no one will come to me for counselling and that can be a very dangerous thing.8221;
Besides affecting counselling, Sunita Wahib, an ex-counsellor, says that anyway by the time a wife wants to know, it is already too late, and she too is affected by it. 8220;And what is the use of talking of partner notification in India? In any case how many women in our country have the right to say no to sex in a marriage? So even if they do know of their husband8217;s HIV status, what can they effectively do about it?8221; She quotes the case of a couple where the husband was infected with HIV, and the wife who was HIV negative wanted to have a baby only to prove to her in-laws that she was fertile and was capable of producing a son for the family.
And this after being counselled about the ramifications of having a baby with an HIV positive man. 8220;The woman was willing to risk her life only to prove her fertility, so what is the use of making partner notification legal,8221; asks Wahib.
If confidentiality is such an important issue in the prevention and control of AIDS then is it not equally important for a doctor to protect the life of an uninfected and healthy spouse? Says Srinivas Pattar, who assists in counselling AIDS patients at the Lokmanya Medical Foundation at Pimpri: 8220;We have had a case where the wife was an ayah at a private hospital and her husband a fruit vendor at a bus stand. She attended one of our workshops and started getting suspicious of her husband. She managed to bring him for counselling. We convinced him of the need to test for HIV and luckily both tested negative.8221; The instance may prove that some women can protect themselves against their husbands. But is it a justification for the all-important information from her?
Pujari says the goal of every counsellor is to coax the patient into telling their spouse or practising safe sex. All this sounds fine on paper, but according to Bianca Talwar, a housewife: 8220;By the time a husband is counselled into informing his wife, or practising safe sex, he would have already infected her by it. In my opinion, if a wife wants to know of her husband8217;s HIV status she should be told. She isn8217;t seeking such information about some stranger, but about her own husband with whom she shares her life and the one who could infect her with it.8221; On the other hand, there are doctors such as Dr S.V. Gore, who says: 8220;I feel like a murderer every time I see an HIV positive getting engaged to be married to an HIV negative girl. But what can I do? My hands are tied. At the most we counsel these people to inform their fiancees, but besides that there is nothing we can do.8221;
Dr S. Mehendale of National Aids Research Institute says: 8220;Without any directive from the policy makers, the doctors have no other alternative but to follow the confidentiality rule.8221; Anand Grover, a lawyer and an AIDS rights activist, believes the government should not change its present policy of doctor patient confidentiality.
In fact, in the US where even the rights of a pets are protected, partners have no right to access the HIV status of the people they are with. Except in the State of New York, where a ruling was passed in a court which stated that it would not be unethical for a doctor to reveal the HIV status to a sexual partner if asked to do so. But even as the law-makers decide on this partner notification issue, lakhs of innocent women may be infected with the deadly virus that will eventually kill them.
