肯尼亞強制檢測HIV設想引爭議

In an effort to combat the spread of HIV, Kenya’s National Aids Control Council and STI Control Program (NASCOP) may soon turn to mandatory testing.

爲阻止艾滋病毒感染在這個東非國家蔓延，肯尼亞全國艾滋病和性傳播感染控制計劃可能不久將在肯尼亞的醫療機構實行強制性檢測艾滋病毒的計劃。

Around 1.5 million Kenyans are estimated to be living with HIV, or about 6.3 percent of the adult population. Prevalence of the disease in Kenya is such that only sub-Saharan neighbors South Africa and Nigeria have more HIV-positive citizens.

據估計，大約有150萬名肯尼亞人是艾滋病毒攜帶者，這個數字佔肯尼亞成人總數的6.3%。肯尼亞的艾滋病毒攜帶者已經多到，在撒哈拉沙漠以南的非洲地區，只有南非和尼日利亞的艾滋病毒攜帶者人數超過肯尼亞。

While analysts say the country has achieved some measure of success in reducing infection rates over the past decade, they estimate that only around 60 percent of Kenyans have been tested for HIV. NASCOP is hoping to have over 80 percent of the population tested by 2013, and is considering new methods to achieve that goal.

儘管在過去10年中肯尼亞在降低艾滋病毒感染率方面取得了一些成功，然而據估計，只有大約60%的肯尼亞人接受了艾滋病毒檢測。肯尼亞全國艾滋病和性傳播感染控制計劃希望，在2013年之前，肯尼亞能有80%以上的人接受艾滋病毒檢測，並且考慮採用新方法達到這一目標。

Earlier this week, Kenya’s Daily Nation reported that the country could adopt new hospital procedures which mandate HIV testing for adults seeking treatments for illnesses such as malaria. The same procedures would require testing for children seeking any Medical treatment.

本週早些時候，肯尼亞的國家日報報道說，肯尼亞醫院可能要採用新的規定，凡是因瘧疾等疾病就醫的成人必須進行艾滋病毒檢測。根據同樣的常規，醫院也必須對前來看病的所有兒童進行艾滋病毒檢測。

A host of ethics questions

Mandatory testing for HIV is generally viewed by rights organizations as a violation of privacy and an open invitation for discrimination. Martin Wood, a spokesperson for British HIV organization Avert, says the push for mandatory testing in Kenya is admirable but misguided and could end up hurting more patients than it helps.

強制檢測艾滋病毒的做法被人權組織視爲侵犯人權。這些組織爭辯說，強制檢測艾滋病毒既侵犯人們的隱私，又公然鼓勵歧視。英國防治艾滋病毒組織發言人馬丁.伍德說，在肯尼亞推動強制檢測艾滋病毒既是值得讚揚的，又是被誤導的，最終可能會傷害病人。

"If they’re in a situation where it’s compulsory that they are going to have an HIV test when seeking medical treatment," he says, "people may actually not go seeking that treatment because they’re scared of disclosure of their HIV status."

伍德說：“如果他們在看病時必須接受艾滋病毒檢測，那麼就可能出現這樣的情況：有些人可能就不看病了，因爲他們害怕暴露自己攜帶艾滋病毒的狀況。”

The problem of social stigma, he explains, could raise public alarm about the proposed testing plans.

社會上的壞名聲問題也使一些人對肯尼亞的艾滋病毒檢測計劃產生了警覺。

Kenya previously attempted to increase HIV testing through its Voluntary Counseling and Testing (VCT) program. VCT centers were opened throughout the country to provide Kenyans with safe locations for testing, but experts -- including NASCOP Director Dr. Peter Cherutich -- say the risk of being viewed as promiscuous prevented many women from accessing services.

肯尼亞過去試圖通過自願諮詢與檢測計劃來增加對艾滋病毒的檢測，全國各地都設有自願諮詢與檢測中心，爲肯尼亞人提供安全的檢測地點。可是，肯尼亞全國艾滋病和性傳播感染控制計劃主任彼得博士等專家說，一旦被檢測出攜帶艾滋病毒，這些女性就會被視爲性濫交，這種風險使許多女性不願意進行檢測。

While education levels within the country have increased in recent years, positive HIV status could threaten a person’s social standing or employment if their status is made public. And according to Asunta Wagura -- the executive director of the Kenya Network of Women with AIDS (KENWA) -- many communities in Kenya still regard positive-status with fear and misunderstanding.

儘管近年來肯尼亞的教育水平得到提高，但是一旦某些人的艾滋病毒陽性反應結果被公開，就會威脅到他們的社會地位和就業。據肯尼亞婦女艾滋病防治網絡執行總監阿桑塔.瓦古拉說，肯尼亞許多社區仍對艾滋病毒陽性反應感到害怕，對病毒感染者存在誤解。"Right now it is not as bad as it used to be," says Wagura. "Things have improved, but still when a person is found to be HIV positive they’re still [exposed to] pockets of stigma and discrimination. I’m wondering now when a person goes for malaria and [is] tested for HIV, whether we have the capacity to handle that. Many cases may resort to suicide."

瓦古拉說：“現在，情況不像過去那麼惡劣。形勢已經改善了。但仍然會出現這種情況，就是說，當某人被發現是艾滋病毒攜帶者時，這還是會給他帶來一些壞名聲和歧視的。我現在想知道的就是，當一個人去看瘧疾時被檢測出攜帶艾滋病毒，我們是否有能力來應對這種狀況。在許多情況下，被查出的感染者往往採用自殺的方式。”

Wagura says that if the program should take shape, post-test counseling for those who do test positive should also be made available. His organization has called on government officials to provide more access to treatment services for Kenyans living with HIV and AIDS in the past.

瓦古拉還對美國之音說，這項計劃應當包括對那些被檢測出攜帶艾滋病毒的人提供檢測後的諮詢服務。艾滋病毒導致艾滋病，目前世界上對艾滋病還沒有有效的療法。這位肯尼亞婦女艾滋病防治網絡負責人呼籲政府向艾滋病毒攜帶者和艾滋病患者提供更多的治療服務。

Legal hurdles remain

But fears of mandatory testing in Kenya are premature, as Kenyan law currently bans such practices.

不過，有些人認爲肯尼亞實行強制檢測措施還爲時過早，因爲肯尼亞的現行法律禁止這種做法。

According to Dr. Andrew Suleh, National Chairman of the Kenya Medical Association, Kenya’s HIV and AIDS Prevention and Control Act (HAPCA) would have to be amended to allow mandatory testing.

安德魯.蘇萊赫博士是肯尼亞全國醫療協會主席，也是肯尼亞全國艾滋病和性傳播感染控制計劃各種政策委員會的成員。他說，爲允許進行強制性檢測，肯尼亞不得不修改艾滋病毒與艾滋病預防和控制法案。而且，肯尼亞的全國艾滋病和性傳播感染控制計劃不光是要研究強制性檢測的問題。

"If somebody has malaria, why would you refuse treatment because you have not tested for HIV?" he says. "It doesn’t make sense."

蘇萊赫說：“如果有人得了瘧疾，在他沒有檢測艾滋病毒之前，你憑什麼拒絕給人家治療瘧疾。這是說不通的。”

Suleh says Kenya's primary goal should be early testing of citizens. Instead of waiting for someone to voluntarily test themselves once they feel sick, he says, NASCOP can do more to stop the spread of HIV by catching new infections early.

然而，這位主席說，肯尼亞最重要的目標是對其公民宣傳早期檢測。與其等候某些人患病之後自願進行檢測，肯尼亞全國艾滋病和性傳播感染控制計劃倒是希望能發現新的感染，以便限制艾滋病毒傳播的範圍。

One interim solution, he says, would be to strongly encourage HIV testing when offering routine treatments for illnesses such as Malaria while allowing patients to opt out.

蘇萊赫說，肯尼亞新方法的起點很可能是在病人接受治療期間允許他們選擇不參加艾滋病毒檢測。儘管在治療瘧疾等疾病期間要大力鼓勵病人進行艾滋病毒檢測，但不會實行嚴格的強制措施。

Because any new approaches would have to be aligned with Kenyan law, however, the nation's battle with HIV will continue to be waged strictly on a voluntary basis.

然而，任何新方法都必須合乎肯尼亞的法律。在法律問題解決之前，肯尼亞抗擊艾滋病毒的戰鬥仍將完全建立在自願的基礎上。