Antibody testing

After the blood donation crisis of November 1984, when the transfusion of HIV positive blood led to the deaths of four Queensland babies, Australia became the first country to introduce comprehensive screening for HIV in donated blood.1 In April 1985, the ELISA test became available in Australia. The ELISA (enzyme-linked immunosorbent assay) test could determine an individual’s HIV status.2 However, once identified as HIV positive, there was little else medical professionals could do. Debate reigned over whether or not those in the at-risk groups – gay men, IV drug users and sex workers – should undergo testing. (It is interesting to note that there was little debate amongst people with haemophilia, a group that widely underwent early screening.) ACON – the AIDS Council of NSW – along with the government and many medical professionals initially advocated testing, arguing that it would provide valuable data for future research. The VAC, however, argued that the negative aspects of testing – including fear of privacy and confidentiality, as well as concerns about the psychological impact on people – far outweighed the benefits. Phil Carswell, then President of the VAC, spoke out against testing, fearing an ‘antibody apartheid’ could develop and positive people could face further discrimination and bigotry.3 Adam Carr wrote a position paper on HIV testing for the VAC, explaining the pros and cons and recommending that the VAC advocate against testing but remain pro-choice.4 The VAC and GMHC maintained a strong safe sex position, arguing that with no medical benefit to knowing one’s status, it was best to assume positive and continue safe sex practices.

Unfortunately, however, while debate raged over whether or not people should get tested, some found out that they were HIV positive unwillingly. Bill O’Loughlin was one of those whose blood sample was back-tested by hospitals when the antibody test came in. After finding out he was positive, O’Loughlin decided to volunteer with the VAC.

I was very strongly of the opinion that there was no value in being tested early on. And simply there wasn’t. My role very early on was to actually work at Fairfield with people that had been diagnosed with AIDS so I saw people die very quickly sometimes, and the doctors could really, in the early years, only make people comfortable. So there was no medical benefit in knowing your status.5

The question of confidentiality and fear of discrimination based on antibody status was amplified when governments tried to legislate for mandatory testing. In August 1985 New South Wales and Queensland tried to introduce compulsory notification legislation. This time all of the AIDS Councils and many medical professionals protested. A survey commissioned by NACAIDS in 1986 found that, of 1500 adults, 47 per cent were in favour of universal HIV antibody testing and 24 per cent in favour of isolating HIV positive people from workplaces and communities. A similar result was found in a poll conducted by The Age a year later.6

When the Victorian government proposed new infectious disease legislation in April 1987, it included compulsory antibody testing. The VAC immediately sprang into action, forming a Political Action Working Group. This group worked together with the GMHC and successfully lobbied the government to remove compulsory testing from the bill.7

Although the VAC initially advocated against antibody testing, it remained pro-choice, encouraging members to make informed decisions. Carswell revealed later, ‘the irony … was that most of the advocates for the anti-testing lobby had gone and got tested privately anyway’.8 The VAC revised its position when medical evidence in support of early detection became firmer.

 


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