Testing in Refugee Situations
Testing in Refugee Situations Available resources for HIV testing should
be devoted, first and foremost, to ensuring a safe blood supply for
transfusions. A voluntary HIV testing and counselling (VCT) programme
is a lower priority in a refugee situation but should not be ruled out
if resources are available and if these services are available in the
host country or were available in the country of origin.
testing to diagnose HIV-related illness may be indicated, but only if
two conditions are met:
pre-and post-test counselling and confidentiality can be assured;
confirmatory testing procedure is undertaken as outlined in UNAIDS
Policy on HIV Testing and Counselling.
known to be HIV infected or to have AIDS should remain within their
communities or within the refugee settlements, where they should have
equal access to all available care and support.
HIV testing in refugee circumstances, with the single exception of testing
blood for transfusion, is not justified. WHO and UNAIDS have determined
that such testing should not be pursued as a matter of policy.
Identifying people with HIV/ AIDS through mandatory testing does nothing
to stop the spread of the virus.
Mandatory testing is a violation of human rights, and it leaves those
who are identified as HIV-positive open to discrimination and persecution.
No negative HIV test can be assumed to have excluded the possibility
of HIV infection in the person tested. There is a latent period of
several weeks following infection, during which the HIV test can come
up negative, but the person is still capable of transmitting the infection
through unprotected sexual contact or blood. Occasionally, too, tests
have shown false negative results.
A negative HIV test offers no assurance that the person tested will
not be exposed to HIV and become infected soon thereafter.
A negative HIV test is, therefore, no reason to relax the universal
precautions that health workers need to observe at all times; nor
does a negative HIV test give any reason to feel that sterile procedures
during medical interventions are any less important. In practice,
every patient should be regarded as a potential carrier of HIV, Hepatitis
B or other blood-borne infections, since testing removes none of the
potential for transmitting these diseases.
UNHCR and International Organization on Migration (IOM) issued a joint
policy in 1990 which strictly opposes the use of mandatory HIV screening,
and any restrictions based on a refugee's HIV status. Nevertheless,
some States have adopted mandatory HIV testing for refugees and exclude
those who test positive. Other States place restrictions on the admission
of persons whom they know to be HIV positive or have AIDS. Although
some countries have established waiver procedures, resettlement cases
of refugees who are HIV positive or have AIDS are certain to be more
complex than most resettlement cases.
Resettlement considerations of refugees living with HIV are difficult
and must be given special attention to avoid placing these persons
at greater risk for discrimination, refoulement, and institutionalisation.