OPTION B+, GENUINE OR GUINEA

A mother walks into paediatric ward and presents a child (3 months) showing all signs of acute pneumonia. Moreover the child has also presented with a maculo-papula rush. " It started two weeks after I gave birth to him, but it has refused to reduce", she laments. You admit the infant and then proceed to do "compulsory" HIV testing for all children and the parents that come into hospital for care at various "entry points". "Proactive" detection they call it.

As you take the blood sample, neither the patient nor the attendant has an idea you are about to perform an illegal RCT on their blood in the name of new government policy and "trying to make their lives ART miserable forever" (without their consent moreover). " we shall keep these RCT results until the patient feels ready to have them". The health worker is taking procedures of highly sensitive psychosocial attributes without consideration whatsoever the impact of their actions. We cannot however blame the health worker because it is now a government policy to infringe on the rights of its citizens. http://www.ugandapicks.com/2013/02/hiv-testing-made-compulsory-79166.html
Moreover it is the reason their is a huge delay in onset of work in  the early morning at any OPD in any government hospital in Uganda. You cannot see the C/O or M/O unless your RCT results are out.

Interestingly option B plus is here. It's not an option as the name suggests. It is actually compulsory. That every child and its mother, pregnant and lactating mothers be tested for HIV and then referred accordingly to start having the bodies pumped with ARV's in the name of not just preventing but " Eliminating mother to child transmission (EMTCT)".  http://www.observer.ug/index.php?option=com_content&view=article&id=24206:new-project-to-curb-hiv-infections-among-infants&catid=34:news&Itemid=114 
And all these has come up as a result of a medical miracle ( I suppose) of a baby girl from Mississippi who got cured of HIV after she contracted HIV from her mother and was detected to be HIV+ during labour(funny). Mississippi baby was put on ART and voilà, some time later she is proved to have no HIV.
http://abcnews.go.com/Health/mississippi-baby-born-hiv-functionally-cured-doctors/story?id=18645410
Assuming the child had contracted HIV anyway and somehow the medical miracle happened. A good sign in a positive direction that HIV could be cured.

But in effect it was on these one miracle that the WHO and now Uganda has decided to start pumping pregnant and lactating mothers plus infants with ARV's in the name of EMTCT. What happened to evidence based medicine? What happened to research? What happened to to systematic ways of introducing new policies? Or is it the WHO now being funded to turn innocent mothers and children into guinea pigs to carry out their "possibility of more ARV cure miracles" with no consideration whatsoever to possible side effects of such adversely strong drugs. No research has come up to confirm "no side effects" on pregnancies and infants but we are proceeding ahead, blindfolded. With no research(es) to untie the blindfold.
http://www.huffingtonpost.co.uk/2013/03/14/hiv-baby-cured-mississippi-child-exposed-infected-virus-dr-mark-siedner_n_2875074.html

We need therefore to proceed with caution. Health of people is not a mere toy play for the scientist to make new "eureka" discoveries. It should be treated with respect and dignity. It is not wise for new policies to come up based on just one mississippi baby miracle. And if B+ is really an option, treat it as such not a compulsory program. Put the money into more research in the field of HIV, pregnancy and ART.




(picture is copyright of http://www.keycorrespondents.org/wp-content/uploads/2013/04/515bd15d63d5c.jpg )