Mandatory HIV Testing

Greece has reinstated mandatory HIV testing for high-risk groups, sparking outrage from international human rights organizations.

In a statement to the news media, Doctors of the World blasted Greek Health Minister Adonis Georgiadis for issuing a decree earlier this month that they say unfairly targets sex workers, drug users, and undocumented migrants for testing.

“This decree is a serious violation of basic human rights, human dignity, and medical ethics,” the statement reads. “It goes against the recommendations of international public health specialists and human rights bodies, including those from the World Health Organization, UNAIDS, the European Centre for Disease Control, and the EU Fundamental Rights Agency.”

According to Doctors of the World, the decree also states that any occupants of housing which “may cause danger to public health” should be evicted from their homes, without any alternative offered. The group called on medical professionals in Greece to refuse to carry out the mandatory testing.

In a statement to Healthline, Georgiadis defended the decree. “The main concern of the Hellenic Government remains the shielding of the nation against public health threats, especially in a country like Greece with an annual massive tourist influx,” he said. “Thus, the government’s political decision to issue a specific health regulation was deemed incumbent in order to both secure interventions concerning emerging and re-emerging diseases at a global level as well as enhance the response to local events of public health significance in high risk populations.”

Georgiadis said that the Greek government “seeks to cover all potential public health threats and emergencies of international significance, as those have been determined by World Health Organization (WHO), European Centre for Disease Prevention and Control (ECDC), and the U.S. Center for Disease Control (CDC).”

A spokeswoman at the CDC declined to comment, and UNAIDS did not return an e-mail seeking comment.

In a report published last year by the ECDC, the agency said transmission of HIV in Greece by intravenous drug users had outpaced the rate of infection among gay men. “This outbreak is occurring at a time when Greece is experiencing an unprecedented and severe financial crisis," the report stated. "It is unclear to which extent the financial crisis has contributed to the outbreak, but it is evident that the crisis has a significant social and health impact on the population of Greece in general, and Athens in particular. In addition, the response of public authorities and civil society to the HIV outbreak is planned and implemented in a context of social and political uncertainty, with extremely scarce financial resources.”

In a statement to Healthline, Dr. Rafael Mazin, senior adviser on HIV/STI and hepatitis at the Pan American Health Organization, Regional Office for the Americas of WHO, said early diagnosis and treatment is critical for people with HIV. He said the public needs to understand the advantages of being tested.

However, he said the policy of WHO is that testing should be voluntary and confidential. “Coercion or pressure not only violates people’s capacity to make informed and voluntary decisions, but also threatens other aspects critical to their treatment, such as retention in the health system and medication adherence. Mandatory testing can produce negative health outcomes, such as mistrust of the health system, fear, stress, failure to recognize the advantages of an early diagnosis, and failures in treatment and in complete viral suppression.”

Other organizations, including the Los Angeles Gay and Lesbian Center, also believe the decree could backfire and worsen Greece's HIV epidemic.

Darrel Cummings, chief of staff at the L.A. Center and an HIV policy expert, said stigmatizing groups at risk of contracting the disease is not only immoral, but also antithetical.

“It's just the absolute wrong approach if the goal is treating people with HIV and making them better and preventing the spread of the disease,” he told Healthline. “There's a worldwide effort right now to get positive people into treatment. “Actions like this are completely contrary to that internationally accepted goal. In fact, they are hostile to it.”

In an opinion piece published in Public Service Europe, Frank Vanbiervliet, European project coordinator for Doctors of the World, said a similar decree was introduced in Greece last year by then Health Minister Andreas Loverdos, from the socialist Pasok party. “It resulted in the round-up and forced testing of hundreds of women,” Vanbiervliet wrote. “Those found to be HIV positive had their names, personal details, and photographs published in the media, on the grounds of 'protecting public health'. After widespread civil society indignation, nationally and internationally, the decree was overturned in May 2012.”

Georgiadis said the new decree is better than the previous regulation. “I want to clarify that the new, improved health regulation will provide for any possible gaps identified during the application of the previous regulation, and naturally it will fully comply with the Hellenic Constitution as well as the international provisions concerning the protection of human rights and international treaties signed by Greece to that effect.”

The issue of forced HIV testing in Greece solicited dozens of responses on Healthline's HIV Awareness page on Facebook. A slim majority of respondents said mandatory testing is a good idea, although some expressed outrage at the idea and others were uncertain.

Jordan Travelyan, who is HIV-positive himself, said he believes mandatory testing could be beneficial. “A lot of people out there are having unprotected sex because either they don't know they are positive and are spreading it around or, worse, they know they are positive and still have unprotected sex and just don't give a damn.”

He said HIV test results should not be made public, however. The decision to be tested and to disclose your status is a personal one. “I am positive and tell my prospective partner right up front. People have the right to make an informed choice. Also, by knowing my status I can do all I can to stay as healthy as possible.”

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