An HIV test with illuminating results

New Delhi — The Globe and Mail

The doctor glanced at the paperwork, pursed her lips, and then looked up with that "this is going to be a bit awkward" expression.



"In India," she said, "we, um, we often test pregnant women for HIV and ….." she trailed off, looking concerned. I jumped in.



"Great!" I said.

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The doctor looked startled.



"I'd love an HIV test!" I said.



Alarmed replaced startled. Her image of me as sedate middle-class wife was clearly being revised.



I'm expecting a baby soon, and the experience of being pregnant in this country has yielded fascinating insights into many aspects of culture and life here, including high-end Indian medical care - the kind you get when you're paying. (Yet not paying that much - those obstetrician appointments run about $12 each.) Women of the Indian middle class have embraced the most-medical-birth-possible model; the epidural, episiotomy, and induction by your due date (if not before) are all standard here. My queries about midwifery and home birth made my doctor flinch.



But the most interesting moment for me, so far, involved this HIV test. During my first pregnancy, three years ago, I was living in Johannesburg, where I was posted as the Globe's Africa correspondent. South Africa had then, still has now, the highest number of people living with HIV in the world. One in three women in Jo'burg of child-bearing age was believed to be living with HIV.



So all through my prenatal appointments, I kept waiting for my doctor to suggest - or order - an HIV test. In Canada, after all, where 0.4 per cent of adults have HIV, the prenatal HIV test is mandatory. I wasn't worried about the results - I was tested for HIV every month or so in my six years in Africa, much of which I spent reporting on HIV. Every time I visited a new clinic or outreach center, the eager staff would ask if I wanted to try out their counseling-and-testing model, or their new rapid result tests. I was quite confident I didn't have HIV - but I was waiting for South Africa, the country with the worst AIDS crisis in the world, to ask me about it.

Didn't happen. Finally, around month seven, I brought it up. "Oh," said my doctor - willowy, gorgeous, a Prada shoe junkie, she is the gynecologist to hip black Jo'burg, or, in other words, the demographic most likely to be infected with HIV - "I guess. If you want." The test was not mandatory, but she ticked it off on the lab form.

Off I went to the lab, intrigued to see what the experience of getting tested in Jo'burg's poshest hospital would be like. The nurse did the other bloods. I looked for the HIV vial, with its tell-tale yellow cap. She didn't have one. I said, "What about HIV?"

"Oh, you don't need that," she said cheerily. "How do you know?" I asked. I could feel my cheeks staining with rage - at the crazy myths about HIV, at the fear and the awkwardness and the assumptions that were fueling its decimation of my adopted home.

"Well, you're…" she stammered. "What?" I asked. I think she may have meant to say white. Or rich. Or both. And so, she had concluded, probably not at risk. "You have no idea who I'm having sex with," I said, angrier and louder now.

"Shh!" The nurse hissed, aghast, and flapped her hands towards my partner Meril, who was waiting outside the open door.

"How do you know that's my husband?" I said. "How do you know who he is having sex with?"

"Ayiee," said the nurse, now simply eager to be rid of me. She reached for the yellow vial, refusing to meet my eyes.

This time around, I was hoping for better. India has a much lower HIV infection rate (about 0.3 per cent of the adult population) and a government that has had successes in fighting the virus.

My Delhi doctor handed me the HIV requisition. It included a section for me to sign stating that as per law, I had received HIV counseling before my test. How progressive! I was delighted with this chance to see India's AIDS control system first hand. I waddled off to the lab and took a number.

When my turn came, the technician took the forms from my hand and snatched up the yellow-lidded vial. I brandished the counseling-received form. "Oh, that," she said. "Sign." I signed and sat back. She knotted off a tourniquet and started probing for a vein. The room seemed fairly crowded for a cozy chat about my sexual history, but I was looking forward to seeing how she handled it.

Holding vial in one hand and form in the other, she used her foot to slide open a vast wooden drawer. I caught a last glimpse of my "I have been counseled on HIV" form as it landed atop a thousand others, then she slammed the drawer shut again.

"The counseling -" now I was the one stammering. "You're supposed to …"

The technician frowned at me and turned away.

"We don't do that here," she said.

"Ever?"

"Nobody wants to talk about that. It's just a paper."

And she yelled for the next number in the line.

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