On Mandatory testing of expectant women

A recent statement made by the Principal Secretary for Nutrition ,HIV and AIDS in the office of the President and Cabinet, Dr Mary Shawa that government policy is that people should go for voluntary counselling and should not be forced baffles me .

The statement was made in reaction to reports from Machinga, where a traditional leader and some people are accusing health workers of forcing expectant women and their husbands to be tested for HIV as a precondition for accessing maternal services at health centres.

Well the Machinga issue is not isolated, there has also been an outcry from one the communities we work with in T.A Malengachanzi, Nkhotakota, where expectant women were worried that they are being forced to get tested and as a result some women shun the hospital and health centre and instead go to Traditional Birth Attendants.

Maybe it is the way the HIV and AIDS Counsellors handle the clients that makes them feel they are being forced. Do we have people from the District Health Office who monitors the conduct of the HIV/AIDS counsellors? Because as Dr Shawa put it that it is an anomaly, then I see that there are gaps in monitoring the HIV counselling and testing services,

There are three types of testing namely: 1.Voluntary Counselling and Testing 2.Diagnostic Testing 3. Routine Testing.

Under Voluntary Counselling and Testing government undertakes to do the following
• Ensure that VCT shall only be carried out with informed consent of the person seeking testing who is prepared with adequate information about the nature of the HIV test, including the potential implications of a positive or a negative result in order to make an informed decision as to take the test or not.
• However a certain woman who went to Malosa Hospital, sad as for her she was not properly counselled, the counselling was done in a group. She said the health worker seemed to be in a hurry.

During a panel discussion organised by Story Workshop, Dr Kelita Kamoto said, as a country we are moving from voluntary counselling and testing to Provider Initiative Counselling and Testing where by it is the responsibility of the Doctor or health worker to do offer the HIV test to the client, however with the right for the patient to opt out.

Dr Kamoto says Malawi has not yet reached the mandatory testing stage yet. Because the patient has a right to decline to the HIV test. But she does not agree with people’s view that it is a violation of the right to freedom and choice for expectant mothers. She said rights should go with responsibilities; their intention is not violate the mother right but to protect the unborn child, if we want an HIV free nation.

Under Routine testing, the National HIV AIDS Policy statement 3.2.2.3.2 states Government shall undertake to do the following:
• Permit HIV Testing without consent in the following circumstances
Sample screening of pregnant women through anonymous unlinked testing for surveillance
• Ensure that HIV testing is routinely offered to all pregnant women attending antenatal clinics unless they decline.

However when I interviewed some pregnant women at Kamuzu Central Hospital, they all claimed that they had little or no choice.

On couple counselling
If the health workers at Ngokwe Health Centre are forcing the pregnant women and their spouses as a pre condition for access to the health services, then it is so sad and it’s uncalled for. Such things happen at post natal clinics in the rural areas when a mother forgets her child’s health passport book. She cannot have access to the services at that health centre.


It is however a good intention by the government to promote and encourage couple counselling and partner disclosure of HIV test results, so men should not be worried when they are told to come along with their expectant wives to antenatal clinics remember we are one body .

I think it is good to get the counselling and results together. I have heard that there are some men who will not go for HCT but will depend on the results of their wives after testing. If for example she tests negative they will celebrate and if she tests positive then you and I know the consequences, only those who have true love for their spouse will carry on their normal lives.

In a nutshell I would want the government to clarify to us on this issue. What’s your comment on this issue?

Listen to Tiombenkota every Thursday at Half past six in the evening (06:30 PM) on MBC Radio 1.
Tiombenkota aims to address HIV and AIDS issues with policymakers, civil society organisations and medical experts. The panellists commit themselves to do action on the problems raised from a community generated programme called Tigwirane Manja which is broadcast every Saturday at half past three in the afternoon.(15:00 hours on MBC Radio 1.