Healthcare providers in India have expressed serious apprehensions over the US Centres for Disease Control and Prevention's (CDC) latest recommendations for healthcare providers' calling for voluntary HIV screening as a routine part of medical care for all patients aged 13 to 64.

The recommendations are in conflict with National Aids Control Organisation (NACO) guidelines, which call for test with consent and counselling. NACO is the nodal agency for HIV surveillance in India.

The recommendations, which would be issued in early 2007 in the US, include regular tests across all hospitals to increase early diagnosis of HIV to improve treatment and prevention. Key components of the recommendations are screening for all patients regardless of risk, voluntary, "opt-out" approach, simplified testing procedures with no written consent or counselling and increased screening for pregnant women.

Dr Jayashree Ramakrishnan, head, department of health education, National Institute of Mental Health and Neuro Sciences (NIMHANS) said, "The recommendations cannot be automatically adopted for India because of serious implications. HIV is a stigma and hence suicides will be on the rise. After diagnosis, treatment and care are grossly inadequate."

Echoing Dr Ramakrishnan's views, Dr K Bharathi, professor and head, department of microbiology, Bangalore Medical College, training coordinator, Regional Resource Training Centre and Medical Officer, Voluntary Counselling and Testing Centre (VCTC), said, "In India, we need to look at the psyche of the patient which is sensitive and could lead to suicides.''

Government sources also see the recommendations as a vicious strategy. They point out that developing countries like India by sheer size of population could push up the sales of the products (kits and drugs) besides become a base of patient pools for HIV drug trials.

Sources from States AIDS Control Societies, NACO, stated that AIDS test is a policy decision, therefore the influence of CDC recommendations will have to be assessed from a country perspective.

"NACO guidelines are sacrosanct. It will be difficult to implement CDC recommendations because NACO will take some time to change guidelines,'' stated Dr. Satish Kumar Amarnath, advisor, Microbiology, Quality Management Resource and chairman Hospital Infection Control Committee, Manipal Hospital.

"The meaning of routine testing is regularly used but its meaning is not very clear. Omitting consent, pre and post test counselling and confidentiality of test results is unacceptable and against human rights. The offer should be routine and not the test," stated Lakshmi Murthy, Advocacy Officer, Lawyers Collective HIV/AIDS Unit.

Safeguards that the CDC recommends such as counselling about HIV, etc. are not workable in the Indian context due imbalance in knowledge and empowerment between doctor and patient. The low levels of HIV literacy among healthcare providers themselves outside of the VCT centres, lack of infrastructure to ensure that adequate counselling is given, etc. are other factors, averred Lakshmi Murthy.

A section of doctors feel CDC recommendations are almost like an unofficial norm for India. There are many hospitals in the country, which are conducting HIV tests without patient's consent or counselling. In fact many corporate and services sectors are conducting HIV tests as a pre employment requirement.