The Constitution and the Bill of Rights together with various statutes protect the rights of citizens to access health care, to access information about their health status and to be informed about decisions affecting their health. Cases which have come before the courts have dealt with instances where these rights have been eroded in the context of HIV. The rights mentioned above and the relevant cases will be discussed below.
4.2.1 The Constitution
The Constitution provides that everyone has a right to have access to health services and the State is obliged to take reasonable legislative steps and other measures within its resources to realize this right.216 Health service is defined by the World Health Organisation as any service aimed at contributing to improved health or to the diagnosis, treatment and rehabilitation of sick people.217 This implies that the Constitution protects the right of every citizen to have access to health services aimed at the treatment and prevention of HIV and AIDS including testing and treatment of the disease. Government also has a responsibility to ensure that every individual has access to testing and treatment for HIV. The South African National Strategic Plan on HIV, STIs and TB for 2012-2016 has made HIV an imperative and sets goals and strategic objectives which if attained will ensure that HIV is detected, treated and managed.218However translating this responsibility into action has proved challenging for the South African government. These challenges will be discussed further in this chapter. In addition to the right to have access to health services, the Constitution also protects an individual‟s right to privacy and confidentiality of any medical information. This would include the right not to have the results of an HIV test disclosed to third parties.219 This however, is not an absolute right and exceptions will be
216 The Constitution Act 108 of 1996 s 27 (a) & (2).
217 WHO Health Systems Strengthening Glossary.
Available at: http://www.who.int/healthsystems/hss_glossary/en/index5.html. Last accessed on 2014/06/25.
218 South African Department of Health. National Strategic Plan on HIV, STIs and TB 2012-2016 P 2,3.
Available at: http://www.hst.org.za/sites/defaults/files/hiv_nsp.pdf Last accessed on 2014/09/13.
219 The Constitution Act 108 of 1996 s 14 (d).
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considered later in this chapter when examining the rights of endangered third parties to have access to such information.
4.2.2 Legislation
The National Health Act provides that every user is entitled to participate in decisions affecting his health and the Act further provides that there is a duty on the health care provider to inform the user of his health status, of any diagnostic procedures and treatment options available to the user.220 In addition the user must be informed of the benefits, risks and consequences of any intended procedure and his right to refuse together with the implications of such refusal.221 These provisions when applied to HIV testing imply that a person must be fully informed of the testing procedure, risks associated with the test as well as the person‟s right to refuse to test.
The Promotion of Access to Information Act provides that a requester must be given access to a record of a public body if he/she fulfills the procedural requirements set out in the Act for obtaining access to such record. This request includes a request for access to personal information about the requester.222 Once a person is tested for HIV he or she is entitled to have access to the test results. These provisions are in line with the Constitution which provide that everyone has the right to access any information held by the state or another person that is required for the exercise or protection of any rights.223
4.2.3 Case Law
Cases that have come before the court pertaining to HIV testing focus on the individual‟s right to privacy, confidentiality as well as the right to provide consent prior to being tested for HIV.
In C v Minister of Correctional Services224 a prison officer tested a prisoner‟s blood for HIV without obtaining proper consent according to the Department of Correctional Services policy for informed consent. The court found that even though the prisoner had consented to the test, there was no pre-test counselling and hence the test amounted to an invasion of his privacy.
220 The National Health Act 61 of 2003 s 8(1).
221 Section 6(1).
222 The Promotion of Access to Information Act 2 of 2000 s 11 (1) (a) & (2).
223 The Constitution Act 108 of 1996 s 32(a) & (b).
224 C v Minister of Correctional Services 1996 (4) SA 292 T.
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In Jansen van Vuuren and Another NNO v Kruger, the court found that disclosure of the plaintiff‟s HIV status to another medical professional after the plaintiff had expressly requested non-disclosure, amounted to unprofessional conduct and a breach of the plaintiff‟s right to privacy and confidentiality.225 The importance of the patient‟s right to confidentiality was highlighted and the court maintained that the medical practitioner had an ethical and a legal duty to respect the confidence of the patient.226
In VRM v Health Professions Council the appellant appealed against the dismissal of an application in which she alleged that her doctor had acted in an improper and disgraceful manner. She had been his patient during her pregnancy and alleged that an HIV test had been carried out on her without her consent and without her receiving pre-and post-test counselling.227 The baby was subsequently stillborn and the doctor only informed the appellant at this stage that she was HIV positive. He also informed her that the cause of death of the baby was HIV. The doctor in his defence stated that he had obtained the appellant‟s consent to the test. He went on to claim therapeutic privilege as a reason for not informing the appellant at an earlier stage of her HIV status and stated that the hospital did not have HIV counselling facilities.228 The decision of the court was that the matter had not been properly decided as there was a dispute of fact. The court directed that an enquiry be held and did not make any further pronouncements on the matter.229
In NM v Smith the appellants appealed against a judgment in the High Court where they had instituted an action for an infringement of their rights to privacy, dignity and psychological integrity following the publication of their names and HIV status in the biography of Patricia De Lille, without their authority or consent having been obtained. Madala J maintained that a person‟s HIV status should not be indiscriminately disclosed especially in a South African context where there is the possibility of discrimination and intolerance arising from disclosure. If people were assured of their rights to privacy, it may encourage them to be tested and receive
225 Jansen van Vuuren and Another NNO v Kruger 1993 (4) SA 842 A.
226 A le Roux-Kemp „HIV/AIDS, to disclose or not to disclose: that is the question‟ (2013) 16 1 PER/PELJ 211.
227 VRM v Health Professions Council of SA and others [2003] JOL 11944 (T) at P4.
228 VRM v Health Professions Council of SA and others supra at 6.
229 VRM v Health Professions Council of SA and others supra at 2.
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treatment for the disease. The recognition of autonomy and respect for confidentiality may also improve public health policies relating to HIV and AIDS.230