Red Cross HIV policy questioned

Red Cross HIV policy questioned

By Renata Arianingtyas

JAKARTA (JP): Jaka (not his real name) donated blood 32 times
between 1987 and July 1996 before he found out he had the Human
Immunodeficiency Virus (HIV).

His first concern was whether he had, through blood donations,
infected other people. An official at the Red Cross said airily
that he had not -- the sample of his blood was taken, tested and
found HIV positive, and so was not given to anyone.

As Support, the magazine for people with HIV or Acquired
Immune Deficiency Syndrome (AIDS), said, Jaka became very upset.
"Why couldn't they tell me outright, so that I didn't give blood
for nothing," he said.

The Red Cross official, however, said the organization was
only adhering to the policy of "unlinked, anonymous and mandatory
HIV-antibody testing", as stipulated by the 1992 Health Law.

The policy states that the object of HIV/AIDS screening is the
blood, not the donors. The argument was that the identity of
donors with HIV/AIDS would be protected.

The problem was, as Jaka pointed out, HIV screening of blood
samples was not mandatory before 1992, while the first HIV-
positive person was found in 1987. There was a possibility that
HIV transmission through blood donations occurred before the law
was enacted in 1992.

Jaka was not the only one.

As of June this year, the official figure for people with
HIV/AIDS was 550, although officials admitted the actual number
could be 100 times higher. About 50 people in the official record
had at one time or another donated blood; in fact, one of them
donated blood 56 times.

AIDS activist Nafsiah Mboi, who is also a legislator of the
Golkar faction, brought this case up in a recent hearing with
Minister of Health Sujudi. She questioned blood donors' right to
be informed of an illness.

As a health expert, Mboi argued that the World Health
Organization applied the principle of "voluntary testing and
confidential counseling", which means that bodies such as the Red
Cross should tell a blood donor, in strict confidentiality, if
he/she was infected by HIV. The organizations should also offer
counseling prior to and after testing.

The same principle, she argued, was also stated in the
national strategy for the campaign against AIDS drafted in 1994
by the office of the Coordinating Minister for People's Welfare.

Sujudi, however, believed the principle of "unlinked,
anonymous and mandatory HIV-antibody testing" was more
beneficial. Although HIV-infected blood cannot be given away for
transfusion, it can still be used for research purposes.

He also pointed out that the government would not have to pay
for counseling before and after testing.

"If we tell people (about whether a blood donor is HIV
positive), they may think blood donations are actually part of an
HIV-screening process. Remember, we are still in short supply of
blood donors," he said.

Policies

Chief of Blood Transfusion at the Indonesian Red Cross,
Melanie Wikanta, said that both policies were actually in effect
and for different reasons.

The first principle, she said, was used for blood transfusions
and survey purposes. The second was only used for diagnostic
purposes, where patients voluntarily ask for screening and are
prepared to face further developments related to their health.

In order to meet criteria of unlinked and anonymous screening,
blood donors have to reveal details about health and sexual
practices.

The Red Cross, for instance, is also obligated to keep donors
anonymous. In practice, however, "we still keep donor files for
emergency cases, such as when we need a certain type of blood,"
she said.

"In addition, there's a decree that screening results of
people with HIV have to be reported to the Ministry of Health. So
it's not really unlinked and anonymous," Melanie admitted.

Melanie pointed out that the policy of unlinked and anonymous
was against a doctor's obligation to inform patients of
illnesses. Samsuridjal, a health expert and activist at the
Pelita Ilmu Foundation for AIDS, agreed, adding that an
uninformed person with AIDS may unknowingly infect others through
means other than blood transfusion.

If informed, a blood donor would be able to take necessary
precautions to avoid infecting others, he said.

Melanie said many countries choose to inform donors if they
have HIV and offer them counseling. "Even some African countries
whose welfare levels are lower than Indonesia's," Melanie said.

In fairness, the Red Cross carried out an experiment in
Jakarta in which donors were given counseling before and after
screening. The medical workers informed donors who were screened
whether or not they had HIV, hepatitis or syphilis.

Only after donors filled in an informed/consent form were
blood samples taken. Those who were found to be HIV-positive were
offered counseling.

Results of the German-funded experiment were promising. "There
was no drastic decline in donors, so the government's concern
about this particular problem was not proven," Melanie said.