Medical muddle

HEALTH Minister Dr Christopher Tufton has been corralled by a consortium of 15 civil society organisations who are demanding that he provide proof to back his edict that the HIV/AIDS Confidential Reporting Form does not comply with existing constitutional and legal requirements and should be pulled back.

This after an outcry from the Love March Movement, a Christian youth non-governmental organisation for sexual purity and the family in Jamaica.

President of the Love March Movement Dr Daniel Thomas, in a social media post on Tuesday, described the information required by the form as a “bombshell” and called on the Ministry of Health and Wellness (MOHW) to explain new designations on the HIV/AIDS Confidential Reporting Form, which, instead of the generic male and female identifiers at birth, now includes other options for selection, namely “male to female transgender”, “female to male transgender”, and “other”, with a requirement that individuals “specify” what “other” references.

“How many genders do the Ministry of Health recognises? How many genders exist? How many genders do the taxpayers and the laws of Jamaica recognise? Can the Government just up and subscribe to a different philosophy that is not reality without consulting its people. Are we really in a democracy, people?” the outspoken Thomas demanded.

“Why is it that medical professionals are being forced to take part in this way of thinking that persons can be born male but then you have to refer to them as female or that they are actually female? That is what this form is saying that the medical practitioner has to fill out. We should not be forced to take part in a delusional system of thinking. These forms, our analyses, and our methods or reporting should be based in truth and reality. If it is that we want to capture the information, to know whether or not persons are suffering with gender dysphoria, we should ask them,” he noted further.

An HIV/AIDS Confidential Reporting Form must be filled out when a person is confirmed with HIV infection, regardless of clinical status; for a person previously diagnosed and reported with HIV clinical stage 1 or 2 who progresses to advanced HIV infection or AIDS; and for an HIV patient regardless of clinical status who now has a CD4 count. Sources of HIV/AIDS Confidential Reporting Forms include public, private, and non-governmental agencies that provide diagnostic and treatment services submit case reports to the national HIV surveillance system. Treatment, care, and support sites are located at public health centres and hospitals throughout the country.

Wednesday, the health minister, in responding to Thomas’s question of whether the ministry he leads is selling out to the LGBTQ agenda, said the ministry had noted the concerns and, “based on an internal review, it was agreed that the form, while supporting a detailed epidemiological profile for public health, does not comply with existing constitutional and legal structures of the Government of Jamaica”.

As such, the health minister said the instrument “will, therefore, be amended to be in full compliance”. Tufton has also requested that a full review be done of all forms and instruments of data collection to ensure that there is congruence with all legal and policy directives of the Government of Jamaica.

The Civil Society Forum on HIV in Jamaica, however, in a swift response has questioned the reason for the “sudden review and proposed adjustment of the form”, while demanding to be told “what on the form violates the Jamaican Constitution”. It is also querying the legal structures with which the form has failed to comply.

According to the consortium, while the need for periodic review of data tools and processes to enhance the public health response is understood, any such adjustment should take into account global practices informed by evidence from technical public health partners and done with the full involvement of critical stakeholders.

The consortium, which includes entities such as Jamaica AIDS Support for Life, Jamaican Network of Seropositives, Jamaica Community of Positive Woman, Jamaicans for Justice, Jamaica Youth Advocacy Network, AIDS Healthcare Foundation, Larry Chang Foundation, Transwave, ASHE Company, Eve for Life, and others, further disputed the minister’s stance that the form was inconsistent with constitutional and legal provisions.

The consortium added that over the years the HIV response in Jamaica has seen the MOHW working closely with civil society organisations as well as communities and constituencies impacted by HIV/AIDS; therefore, “it is deeply disheartening that such a crucial matter, which has implications for all stakeholders, was decided without broader consultation with the HIV response community”.

“The absence of dialogue with agencies who do provide HIV-related prevention, treatment, and care and would be well-positioned to offer input can only serve to erode decades of trust and consensus-building that were critical underpinnings in the reduction of new HIV infections which declined by 62 per cent between 2004 and 2021,” the statement read, while urging the health minister to reconsider as the current approach stands at odds with the core principles of an evidence-based public health response.

The Jamaica Observer’s attempt to reach the health minister to answer queries about when the change being disputed was made was unsuccessful; however, a ministry source with whom the newspaper spoke said it could have been inserted as far back as 2017.

The Observer’s own research revealed a June 2012 draft MOHW operational manual titled “Guidelines for HIV Case-based Surveillance”. Under the heading “Instructions for completing HIV/AIDS Confidential Reporting Form”, which directs providers on the data necessary in the forms, an insert which might explain the change now causing the firestorm was seen.

The document, in designating information relating to “sex” as a requirement states, “This field denotes the patient’s biological sex at the time of diagnosis, primarily male (M), female (F). (Current sex may vary from the patient’s sex at birth, for example, where a patient has had sexual reassignment surgery).”

However, the questionnaire seen in that document, in respect of identifiers, only asked individuals to identify as male or female. Efforts to reach acting director of the Health Promotion and Protection Division in 2012 Dr Kevin Harvey, who was one of three to sign off on the draft document, were fruitless.

It is not clear when the document moved from being a draft.

On Wednesday, Opposition spokesman on health Dr Morais Guy, while noting that he was “in the dark” about the developments, appeared to side with his Government counterpart.

“I would have to speak to my advisory team because it borders on not only a health concern or issue but also a constitutional or legal matter, and it would be unwise of me to comment on something I am not too au fait with. But, to me, anything that is done ought to reflect the current laws of the country we live in, even though we live in a world where there are different assignments when it comes on to gender,” Dr Guy told the Observer.