Reprinted from The Times of India News Service, September 21, 2000
HIV Testing Questioned
By Rupa Chinai
 
“An HIV positive test usually means a ‘death sentence.’ But AIDS counselors and doctors are finding that a positive result is fraught with problems and can sometimes be false. The validity of the HIV test hence needs re-examination, they say…”
 
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Mumbai, India: An HIV positive test usually means a “death sentence” for most patients. Over the past year however, AIDS counselors and doctors in Mumbai are realizing that this need not always be the case. They are finding that an HIV positive test result is fraught with problems when it shows up in an asymptomatic person who does not have the clinical symptoms of AIDS. This is because the results can sometimes be false. The validity of the HIV test hence needs re-examination, they say.
 
Also of concern are some unusual trends they are seeing, that do not conform to what is the known picture of HIV\AIDS. Why, for instance, are some people progressing into it faster than others? Why are others remaining healthy even a decade after being diagnosed as HIV positive? Are our public health messages giving information that empowers people to take responsibility for themselves, or are they whipping up unwarranted hysteria and fear?
 
Counseling and Allied Services for AIDS (CASA), a Mumbai based NGO cites the instance of two women who experienced the havoc caused by a false positive result - false, as it later turned out - when they were subject to a mandatory HIV test during routine enrollment in a hospital for child birth.
 
Shuttling from one hospital to another, faced with rejection, the traumatized women ultimately delivered their babies. After birth, the infants were administered a course of AZT, a highly toxic and controversial anti-AIDS drug. The mothers were made to feel afraid of handling their babies and feed them, for fear of passing on their infection. In time, the women underwent a second HIV test, but this time it turned out to be negative.
 
“Being HIV antibody positive does not mean being virus positive'', insists Manu Kothari, professor of anatomy at Mumbai's KEM Hospital. This view is also held by several Western scientists who say HIV testing in Asia and Africa is fraught with problems. There are at least 70 different pre-existing conditions - including malaria, TB, malnutrition, fever, the common cold and even the condition of pregnancy - that could cause cross-reactivity, leading to a false HIV positive result. According to these scientists, the problem arises because the HIV test is not specific for detection of the virus. The literature accompanying the Eliza test kits (Abbott Laboratories for instance) amply clarifies that the presence of antibodies does not necessarily confirm the presence of the virus.
 
Alka Gogate, a microbiologist, and project director of the Mumbai AIDS Society concedes that reliance on a single HIV test is not acceptable in labeling a person as `HIV positive'. At least three confirmatory tests are required to eliminate the possibility of picking up other infection markers. Many private laboratories in the city lack accreditation and technical expertise to assure standardized testing, she says.
 
“The possibility of false results is true for any test - be it hepatitis, typhoid or AIDS - where a small fraction of the results are likely to be false. It is important that people know this. Ideally the test should not be done when a person is suffering from high fever or other infections. People have a right to reject mandatory testing imposed by private hospitals. They should go for voluntary HIV testing when their physician suspects they have symptomsindicative of clinical AIDS'', Dr. Gogate says.
 
CASA and several other counseling groups meanwhile report that there is strong evidence to show that the damage caused to the immune system can be reversed with right nutrition, changed lifestyle, a supportive family and good counseling. Experts concede that this is “an accepted medical phenomenon''.
 
“We have seen so many cases of people who remain well despite testing HIV positive since the past decade. Many of them even putting on weight. There is need to empower people with this information so that they can take control, rather than feeling helpless. We have seen that it is making a difference, and this is not just hearsay'', says Gayatri Titus, a counsellor at Conwest Jain Clinic and Harkisondas Hospital.
 
Counselors are meanwhile bewildered by some trends seen, that do not conform to the set pattern of infection transmission. Why for instance, are they seeing “discordant couples” where one partner is HIV positive and the other remains negative, despite their failure to use condoms?
 
Western scientific literature has also noted this phenomenon and raised the possibility of whether anal sex, in combination with factors of antibiotic or recreational drug abuse, and nutritional stress, could lead to the progression of AIDS. At least two Mumbai studies point to the alarming progression of AIDS in the city's gay community and amongst its migrant workers who are vulnerable to homosexual practice. Could the practice of anal sex be a determinant in the progression of AIDS amongst couples who practice anal sex?
 
According to Priyadarshini Roy, a researcher at CASA, there is need to re-examine what is known, and a greater openness to accept that what we are seeing calls for other explanations.

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