By Glenda Anderson, Staff ReporterSURGEONS IN some hospitals across the island are carrying out HIV tests on patients without their knowledge, before surgeries are performed.
One woman told The Sunday Gleaner that she had been booked for major surgery in a private hospital and was brought documents to be signed. But among the package were requests for laboratory tests which had already been identified and signed for by the doctor.
WAS NOT CONSULTED
"It wasn't until later that I actually saw the results and realised that the doctor had sent to have tests done for HIV in addition to the others. She didn't even ask me anything," she said.
She said that at no point during pre-surgery interviews was she told that an HIV test would be done, neither was she informed of any counselling which would have been available to her if the result had been positive.
A highly reliable source in the health sector also confirmed that several persons had confided that blood samples had been taken from them for HIV testing prior to surgery, often without their knowledge. Another doctor who requested anonymity said he fears his associates may be asking that the tests be done in order to discriminate against people living with HIV/AIDS. Executive director of the National AIDS Committee, Dr. Robert Carr, said in other cases doctors flatly refused to operate on persons who the tests confirmed to be HIV positive. The cases, he said, were rarely mentioned.
"Because people are afraid to disclose their status, people don't complain at all. We are very concerned, and completely against it and find it totally against people's rights to quality for health care," he said.
PRECAUTION
"If it is a routine procedure for surgery, good, but not when you're going to be 'selecting' patients for HIV tests, without justifiable cause. Use universal precaution if it is that you feel the need to provide additional care, that is you treat all cases as potentially infectious. Wash hands frequently, use gloves when taking samples, and wear personal protective equipment," he said.
But the Association of Surgeons, maintain that doctors are within their rights to request the tests, as long as permission is given by the patient and further, that doctors can also refuse to perform the surgery if the patient refuses to do the test.
Head of the Association of Surgeons, Dr. Trevor McCarthy, said the practice though, if and where it existed was not sanctioned.
"It's certainly not a public policy. You must get permission, before an HIV test is done on any patient," he said.
"The doctor must have 'informed consent' that is, the patient must be told, and must agree, (even as) the doctor has the right to request the test if he/she believes that there is reason to know the HIV status of the patient," he said.
Dr. John Hall, president of the Medical Association of Jamaica, agreed noting that doctors indeed had the responsibility to determine the "full medical status of their patients in order to provide quality care."
FULL DISCLOSURE
"The doctor is entitled to have full disclosure from the patient. AIDS is just another (infectious) disease, and is to be treated as we would do for other serologically relevant diseases," he said. (Serology is the scientific study or diagnostic examination of blood serum).
But while no formal complaints have been lodged with the Ministry of Health, officials have joined in condemning the activity.
"As a general rule, HIV testing should only be undertaken with specific informed consent of the person being tested. The general rule that HIV testing should only be conducted based on specific informed consent does not apply to the testing of donors of blood, organs, semen, similar bodily products. There is no justification for mandatory or compulsory testing of surgical patient preoperatively. It is unacceptable and unethical clinical practice in Jamaica," the Ministry said in response to Sunday Gleaner queries.
Responding to questions on the possible reasons behind doctor's taking such a position, senior officer with the National AIDS programme Dr. Yitades Gebre said:
"Some surgeons may believe that by screening preoperative patients for HIV they may protect their chance of HIV exposure by ensuring extra precautions and avoid major invasive procedures."
