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Frerichs, R.R. Response to Acceptance of HIV Personal Screening.

SEA-AIDS Network, June 13, 1998.

Posted in response to:

SEA-AIDS, June 12, 1998

From "Ditch" Townsend, Malaysia

Professor Ralph Frerichs posted his view of changing attitudes to personal HIV testing. If he were only focusing on developed countries, I would be less uneasy with his conclusions. However, he seems to present only two dimensions of the issue, instead of at least four I can identify. 

His first dimension is the focused position, i.e.: "Personal HIV testing is unethical." He treats us to a discussion of the process to changing to a new position along a two dimensional line. So far so good, indeed I could accept the abstract argument with few questions.

The problem is, that a third dimension - context - appears to be ignored. For instance: I do feel that in general, the availability of personal testing in a developed context (e.g.: the UK) is defensible. But in Cambodia recently, doing some project development consultancies, I did not feel I could endorse a proposal to actively promote and provide HIV testing. In between in Malaysia (where I work), I feel there are pros and cons and can not easily come down on either side of the fence.

The fourth dimension is the individual versus communal context. Even in Cambodia, there may be individual people who I would recommend to go and find themselves an HIV test. The corollary is that in England I might identify individuals who's lives could be crushed by the knowledge of HIV infection.

The point is not, as Professor Frerichs appears to indicate, to win people over per se (I am won over). The point is to balance the pros and cons both communally and personally (which would lead me to vary my position).

'Ditch' Townsend (Dr)

AIDS Project Development Advisor 

R.R. Frerichs Posting

I am responding to Dr. 'Ditch' Townsend who commented about my June 10 posting. Before starting, I should point out that I do not know Dr.Townsend, and thus have no personal feelings towards him.

Instead I am merely reacting to what was written by someone, who happened to be named Dr. Townsend. He also does not know me, so his comments about my posting were taken in the same spirit (i.e., not personal). Dr. Townsend raises an interesting point when he writes about context (what he describes as a "third dimension"), suggesting that testing issues may be different in developed versus developing countries. This certainly could be true. While the testing policies that are being addressed in our correspondence may be intended for developing countries, the funds to support these policies often come from wealthier societies or from international agencies such as UNAIDS or UNDP that derive much of their support from economically developed countries. What is considered standard or ethical practice in prosperous nations has a dramatic effect on what is being done in poorer societies.

Dr. Townsend provides an interesting example of this phenomena. He writes, ..."the availability of personal testing in a developed context (e.g. the UK) is defensible. But in Cambodia recently, doing some project development consultations, I did not feel I could endorse a proposal to actively promote and provide HIV testing."

If his reluctance to endorse HIV testing in Cambodia is merely an opinion which is subject to debate and discussion, then all would be well. In this kind of free exchange of ideas, the best argument would win out, where "winning" means optimum benefits for the Cambodian people.

But what if there is no free exchange? What if the lack of endorsement by Dr. Townsend had an influence on the funding agency, and no tests were made available to Cambodia? Then the origins of his opinions would be important to understand, including the cultural context in which his thoughts were formed. 

Since for most people in the developing world, the origin of their consultant's thinking is in the West, the possible shift in thinking towards personal screening that is occurring in the United States should be of interest. Once this shift of opinion becomes more widespread throughout the United States, Europe or other donor societies, then funding for personal screening efforts will increase in the high-prevalence countries of Asia, Africa and South America, and new testing strategies that feature personal screening will be tried and evaluated.