FIJI faces a deepening HIV crisis as health workers living with the disease refuse to be tested or declare their status.
Many doctors and other health workers who have been affected remain reluctant to seek treatment because of stigma in the workplace.
“We’ve had doctors and healthcare workers dying from HIV because they’re too afraid of going on treatment because they don’t want their colleagues to know that they have HIV,” Dr Jason Mitchell told a Fiji Medical Association mini conference at the weekend.
Mitchell – the National HIV outbreak and Cluster Response Chair – said the country’s HIV response confronted a reality that once sat on the margins of the debate.
Discussion during the FMA conference painted a picture of a system under pressure from several directions at once: weak procurement, limited testing supplies, staff shortages, and a growing number of patients diagnosed late.
That shortage is becoming more expensive as the caseload rises.
Mitchell estimated that if all people who should be diagnosed were on treatment and the country also treated opportunistic infections, sexually transmitted infections, and tuberculosis, Fiji would need about $150 million a year.
“(The Fiji Pharmaceutical and Biomedical Services) budget alone is less than $48 million,” he said.
HIV Testing and Consent
The discussion also turned to testing and consent, with the emergency departments already screening patients who appear to be at high risk, but Mitchell warned that Fiji’s HIV law required informed consent.
“It is unlawful to test anyone without informed consent,” he said, adding that the country should move toward “opt-in, opt-out testing” rather than testing without permission.
“That’s a part of the legislation that is problematic, and I think many of the clinicians in the room will share that view. It creates many barriers to diagnostics, and I think most clinicians that I know, and I won’t name them, just test.”
“But there will come a time when somebody will be taken to court for that, and you’ll be found guilty because it’s a clear-cut case. No consent was given. It’s an assault case,” he said.
Mitchell said the old model, in which patients were referred out of the hospital to specialist services, no longer fitted the scale of the outbreak.
“The epidemic is big enough,” he said.
“Everyone should be trained in HIV to be able to put people on treatment themselves.”
“The response now depends not only on treatment and testing, but on keeping patients in care long enough to suppress the virus and prevent the cycle of late diagnosis, opportunistic infection and repeat hospitalisation.”
Clinicians have shared similar sentiments, saying targeted testing would make better use of limited resources, focusing on people at the highest risk, including sex workers, people who inject drugs and people without stable housing.
Dr Priya Kumar added the country recorded 92,773 HIV tests last year and argued that broad, untargeted screening was not the best use of scarce kits and staff.
Staffing emerged as another pressure point. She said the sexual and reproductive health and HIV unit was working at “30 per cent capacity,” with only two medical officers seeing about three new cases a day.
“A new case will at least take an hour consult because you need to counsel them, and where will the staff come from? It will be coming from the existing workforce from one location to another.”
