AIDS programme in whose aid

AIDS PROGRAM IN WHOSE AID

S.G.Kabra
Senior Scientist, IIHMR, Jaipur

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Of late, there has been a great deal of activity on AIDS awareness and control. Anybody who is somebody in the health sector, NGOs et al., appears to be concerned about AIDS.. Yet, it seems that all sponsored, funded and media hyped activities concretize to no specific guidelines or mandatory protocols when a seropositive HIV case is identified. Identification of such a case takes place in a hospital or, more specifically, in a testing laboratory. And there is no mechanism that the identifying doctor can put in motion to prevent the identified HIV positive person from spreading it. What is more, seropositivity with HIV is not even declared a notifiable condition about which it is mandatory to inform a designated nodal agency. A medical man confronted with an HIV positive case finds all the hyped awareness and prevention campaign measures farcical, and ends up just counseling the carrier, hoping against hope that good sense will prevail. Here are the details of a recent case to substantiate the point.

A 21 year old young man suffering from low grade fever, loss of body weight and generalized lymph node enlargement of the body was suspected to be a case of lymphoma (a type of cancer of lymph nodes). He had been referred to a reputed hospital laboratory for histopathological examination of his lymph node that had been removed (biopsied) elsewhere.

The pathologist did not find evidence of lymphoma in the lymph node. But, by the microscopic changes seen in the section of the node, he got suspicious of the possibility of HIV infection in the case.

The young man was taken into confidence and it was suggested that the pathologist would like to rule out the possibility of HIV, and for this he would need to do a blood test on him. The young man's blood was tested for HIV by the Elisa Method. It turned out to be positive.

When the patient returned after a couple of days to learn about the test findings, he was informed that he had tested positive for HIV. Being an educated person, he immediately understood what it meant and implied.

When asked about his sex life, he flatly denied any exposure and said he was unmarried. He was asked if he had had any transfusion of blood; he said had not. He was asked about any injections that he had taken, and he had taken no injections.

The young man was told about the Elisa method by which the test had been done in the laboratory. It was explained to him that the test gave false positive results in 3 - 5 % cases. To be certain that the test result in his case was correct, he was advised to get the test done by a more specific method i.e. the Western Blot Test.

The young man returned after a week. He apologized to the doctor and said he was sorry he had lied. He admitted that he along with four of his friends had visited “a place” and had sex with a girl. He further confided to the doctor that he had also lied about his marital status. He was married. However, he told the doctor that as yet `Gauna'(*) ceremony had not been performed and, therefore, his `wife' had not yet come to his place. He also confided that the girl (wife) was still studying and only on completion of her study would Gauna take place.

He asked the doctor for his advice. He wanted to know what his fate would be . "Is it certain that I am doomed to die of the disease ?", was his specific question. To this, the doctor's reply was that it usually took 5 - 10 years for the disease to manifest itself in its fatal form, and hopefully, by that time a cure for the disease would be found out. He was apprised of the likely course and progress of the disease. The possibility of his transmitting the disease to his sex partner was explained to him. He was told to disclose the fact of his HIV positivity to his `wife-to-be' and take her informed consent. He was advised about safe and protected sex life, and was warned not to donate his blood for anybody. He was also informed about transmission of infection through unsterilised needles.

The identifying doctor had done all that the was required to do. The farce of the situation is that this is all that he was required to do. Consider the following points in this regard :

1. Did the doctor do all that he was required to do ethically, morally and legally?

2. Was the doctor ethically, morally, legally and socially responsible to ensure that his patient did not transmit the disease to innocent persons ? If yes, how was the doctor to ensure it ?

3. Considering the nature of the infection , the doctor should have found out about the patient’s friends who had visited the source of infection and subjected them to the same test. Did he have the power to do it ? Could the boy be compelled to disclose the names of his friends ?

4. The doctor should have found out the source of the infection and then conducted the test on that woman. Was he empowered to do it ? Could the woman be compelled to submit to the test ?

5. Supposing the doctor did locate the source of the infection and confirm that the woman was HIV positive, how was he, then, to ensure that she did not transmit the disease any further ?

6. Did the doctor have any duty towards the girl betrothed to the HIV positive patient, whose name and address he had not been told ? Knowing that the girl was at prime risk what should he do ?

7. What about the implications of the recent Supreme Court Judgment ( (1998) 8 SCC 296) declaring that transmission by a seropositive HIV person to another (in the instant case his wife-to-be), would amount to be an offence under Sections 269 and 270 of the IPC ? Also to be considered is the relevance and import of Sec. 39 of Cr.P.C. in this context. Having come to know that a person is going to commit a cognizable offence, not informing the appropriate authority about it is a crime. __________________________________________________________________
P.S.
IPC Section 269 and 270 are excluded from the purview of Sec. 39 Cr.P.C.
However, Sec. 116 of IPC and other sections of IPC related to abatement, are relevant in the context of offence committed or to be committed under Ss.269 & 270 of IPC. Where does the physician having knowledge of the patient's intention to commit offence under IPC 269 and 270 stand in the light of the Supreme Court judgment ? What should he do to avoid becoming an abettor in the crime ?

Gauna = A mandatory ceremony essential to be performed to complete the marriage ritual (including child marriage) before the bride is sent to the bridegroom’s place and cohabitation is permitted. It is performed after the girl has attained puberty ( in case of child marriage), and when the parents of the girl consider it fit and appropriate.


Dr.S.G.Kabra
MBBS,LLB,MSc,MS (Anat.),MS (Gen.Surg)
Senior Scientist
IIHMR
Jaipur