肯尼亚强制检测HIV设想引争议

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.

为阻止艾滋病毒感染在这个东非国家蔓延，肯尼亚全国艾滋病和性传播感染控制计划可能不久将在肯尼亚的医疗机构实行强制性检测艾滋病毒的计划。

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.

据估计，大约有150万名肯尼亚人是艾滋病毒携带者，这个数字占肯尼亚成人总数的6.3%。肯尼亚的艾滋病毒携带者已经多到，在撒哈拉沙漠以南的非洲地区，只有南非和尼日利亚的艾滋病毒携带者人数超过肯尼亚。

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.

尽管在过去10年中肯尼亚在降低艾滋病毒感染率方面取得了一些成功，然而据估计，只有大约60%的肯尼亚人接受了艾滋病毒检测。肯尼亚全国艾滋病和性传播感染控制计划希望，在2013年之前，肯尼亚能有80%以上的人接受艾滋病毒检测，并且考虑采用新方法达到这一目标。

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.

本周早些时候，肯尼亚的国家日报报道说，肯尼亚医院可能要采用新的规定，凡是因疟疾等疾病就医的成人必须进行艾滋病毒检测。根据同样的常规，医院也必须对前来看病的所有儿童进行艾滋病毒检测。

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.

强制检测艾滋病毒的做法被人权组织视为侵犯人权。这些组织争辩说，强制检测艾滋病毒既侵犯人们的隐私，又公然鼓励歧视。英国防治艾滋病毒组织发言人马丁.伍德说，在肯尼亚推动强制检测艾滋病毒既是值得赞扬的，又是被误导的，最终可能会伤害病人。

"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."

伍德说：“如果他们在看病时必须接受艾滋病毒检测，那么就可能出现这样的情况：有些人可能就不看病了，因为他们害怕暴露自己携带艾滋病毒的状况。”

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

社会上的坏名声问题也使一些人对肯尼亚的艾滋病毒检测计划产生了警觉。

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.

肯尼亚过去试图通过自愿咨询与检测计划来增加对艾滋病毒的检测，全国各地都设有自愿咨询与检测中心，为肯尼亚人提供安全的检测地点。可是，肯尼亚全国艾滋病和性传播感染控制计划主任彼得博士等专家说，一旦被检测出携带艾滋病毒，这些女性就会被视为性滥交，这种风险使许多女性不愿意进行检测。

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.

尽管近年来肯尼亚的教育水平得到提高，但是一旦某些人的艾滋病毒阳性反应结果被公开，就会威胁到他们的社会地位和就业。据肯尼亚妇女艾滋病防治网络执行总监阿桑塔.瓦古拉说，肯尼亚许多社区仍对艾滋病毒阳性反应感到害怕，对病毒感染者存在误解。"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."

瓦古拉说：“现在，情况不像过去那么恶劣。形势已经改善了。但仍然会出现这种情况，就是说，当某人被发现是艾滋病毒携带者时，这还是会给他带来一些坏名声和歧视的。我现在想知道的就是，当一个人去看疟疾时被检测出携带艾滋病毒，我们是否有能力来应对这种状况。在许多情况下，被查出的感染者往往采用自杀的方式。”

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.

瓦古拉还对美国之音说，这项计划应当包括对那些被检测出携带艾滋病毒的人提供检测后的咨询服务。艾滋病毒导致艾滋病，目前世界上对艾滋病还没有有效的疗法。这位肯尼亚妇女艾滋病防治网络负责人呼吁政府向艾滋病毒携带者和艾滋病患者提供更多的治疗服务。

Legal hurdles remain

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

不过，有些人认为肯尼亚实行强制检测措施还为时过早，因为肯尼亚的现行法律禁止这种做法。

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.

安德鲁.苏莱赫博士是肯尼亚全国医疗协会主席，也是肯尼亚全国艾滋病和性传播感染控制计划各种政策委员会的成员。他说，为允许进行强制性检测，肯尼亚不得不修改艾滋病毒与艾滋病预防和控制法案。而且，肯尼亚的全国艾滋病和性传播感染控制计划不光是要研究强制性检测的问题。

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

苏莱赫说：“如果有人得了疟疾，在他没有检测艾滋病毒之前，你凭什么拒绝给人家治疗疟疾。这是说不通的。”

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，这位主席说，肯尼亚最重要的目标是对其公民宣传早期检测。与其等候某些人患病之后自愿进行检测，肯尼亚全国艾滋病和性传播感染控制计划倒是希望能发现新的感染，以便限制艾滋病毒传播的范围。

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.

苏莱赫说，肯尼亚新方法的起点很可能是在病人接受治疗期间允许他们选择不参加艾滋病毒检测。尽管在治疗疟疾等疾病期间要大力鼓励病人进行艾滋病毒检测，但不会实行严格的强制措施。

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，任何新方法都必须合乎肯尼亚的法律。在法律问题解决之前，肯尼亚抗击艾滋病毒的战斗仍将完全建立在自愿的基础上。