A Health and Human Rights Perspective on Providerinitiated Testing and Counseling in the Health Care

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A Health and Human RightsPerspective on
Provider-initiated Testing and Counseling in the
Health Care Setting

• Daniel Tarantola

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Health, Ethics and Human Rights
A state of physical, mental and social well-being
Health
Human Rights
Individual ands collective concerns to do whats
right and just
Ethics
Governmental obligations towards people
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Contemporary public health

• Historical roots
• Social justice and the birth of public health
• Agent, host and environment
• Isolation, quarantine and cordon sanitaire
• Public health and the emergence of HIV
• Health and Human Rights

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Human Rights

• Legal claims that persons have on society simply
  on the basis of their being human
• They are  what governments can do to you,
  cannot do to you and should do for you
• Governmental obligations to
• Respect rights
• Protect rights
• Fulfill rights
• Human rights are universal, indivisible,
  inalienable, and interdependent (Vienna, June
  1993)

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Value of Human rights

• Ideological
• Aspiration
• Normative content
• Legal
• National law
• International human rights law
• Instrumental
• Norms and standards
• Organizing principles
• Public health practice
• Accountability

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International Human Rights Documents Relevant to
HIV Testing

• 1948 Universal Declaration of Human Rights
  (UDHR) 
• 1965 International Convention on the
  Elimination of All Forms of Racial
  Discrimination
• 1966 International Covenant on Economic,
  Social, and Cultural Rights
• 1966 International Covenant on Civil and
  Political Rights
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• 1979 International Convention on the
  Elimination of All Forms of Discrimination
  Against Women
• 1985 Convention Against Torture
• Convention on the Rights of the Child
• 2003 Convention on Migrant workers
• 2007 Convention on Disability
• And many other HR international and regional
  charters and declarations

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Progressive realization of rights

• Within the capacity and to the maximum of the
  ability of States
• Commitment and National benchmarks
• Accountability
• Who is counted? Who is not?

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Public Health Imperatives

• Governments have the right to take the steps
  they deem necessary for the prevention,
  treatment and control of epidemic, endemic,
  occupational and other diseases.
• Article 12 (c) of the ICESCR

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• Valid Restrictions on Rights
• The Siracusa Principles
• The restriction must be provided for
• and carried out
• In accordance with the law
• In the interest of a legitimate objective
• As strictly necessary
• If no less intrusive and restrictive means is
  available, and
• If not unreasonable or otherwise discriminatory.

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PITC in Practice
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The utility of human rights for public health

• HR as organizing principles
• Health as a human right (UDHR Art. 24 and ICESCR
  Art. 12) and general comment 14 (2000)
• Governmental obligations and actors
• Respect rights
• Protect rights
• Fulfill rights
• All sectors of society have a role to play

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Convergence of health and human rights

• Human Rights
• Right to health
• Right to life
• Equality
• Non-discrimination
• Free movement
• Information
• Participation
• Association
• Privacy
• Autonomy
• Bodily integrity
• Benefits of scientific progress
• .

• Health
• Policies and laws
• Prevention interventions
• Information and education
• Patient/Provider relations
• Access to medicines
• Behavior change
• Data collection, analysis and reporting
• Testing and Screening
• Isolation and Quarantine
• Treatment and support
• Research
• Environmental interventions
• .

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Optimizing Health and Human Rights
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What form of HIV testing?
Provider recommended
Unlinked testing
Universal testing
Voluntary
Screening
Informed consent
Confidential testing
Routinely offered
Compulsory testing
Home based testing
Anonymous testing
Opt out
Provider initiated
Mandatory
Post-test counseling
Group counseling
House to house testing
Routinely performed
Client initiated
Systematic testing
Opt in
Pre-test counseling
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Four Health and Human Rights imperatives

• Advancement of human rights
• Participation
• Equality
• Accountability

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Four requirements Health Services

• Availability offered to the maximum availability
  of resources available to governments.
• Accessibility attainable by everyone without
  discrimination
• Acceptability appropriate for the intended
  populations and
• Quality scientifically and medically appropriate
  and of the optimal quality.
• General Comment 14 on the Right to Health
• COMMITTEE ON ECONOMIC, SOCIALAND CULTURAL
  RIGHTSMay 2000

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Do Dont

• Mandatory HIV testing
• Neither
• Routinely practiced
• Disclosed
• Without counseling
• Without consent or knowledge
• With no option out
• With penalty if opting-out
• With no access to prevention, care and support

• Voluntary HIV testing
• Patient/Client or provider initiated
• Routinely offered
• Anonymous
• With pre- and post-test counseling
• With informed consent
• With possibility of opting-out
• And if so with no penalty
• With access to prevention, care and support

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Action and policy
Provider-recommended HIV testing
Scaling-up HIV testing

• Needs
• Opportunities
• Obstacles

Key actors Communication Advocacy
Policy change Monitoring Accountability
Inducing policy changes
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• Guyana
• US EMBASSY RAPID TESTING PROCEDURES APPEAR TO
  BE  EXCESSIVE NATIONAL AIDS COMMITTEE CALLS FOR
  MORE DETAILS
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• The National AIDS Committee (NAC) is deeply
  concerned over the recent announcement by the US
  Embassy that it is carrying out its own HIV rapid
  testing on the Embassy premises.
•  
• In a circular dated May 24, 2007 the US Embassy
  stated that  All (visa) applicants who will be
  asked to undergo a HIV rapid test have already
  had a medical examination, HIV test counseling,
  and HIV rapid test by a previous panel physician.
  Due to the confidential nature of the medical
  program and to protect the right to privacy each
  applicant is entitled to, the Consular Section
  cannot discuss the details of the medical
  program.