Mandating pre-marital HIV testing

January 20, 2007 at 1:23 am (Sarah's Posts)

There has been a lot of debate in the papers and among public health officials in India about making pre-marital HIV testing mandatory. There are several goals, but the most talked-about is to empower women who don’t have the right to ask for an HIV test for their potential partner. I can understand the goals of this program, but there are so many social implications of mandating HIV testing. What happens when one of the couple comes up HIV positive? Does this give people a false sense of security that will make them complacent after marriage? Ideally, the issue of women’s empowerment needs to be addressed by actually empowering women, instead of blanket mandates. This is a start that could allow women (and men, of course, in the opposite case) to begin protecting themselves. But it doesn’t address the fact that a wife may not be able to ask her husband to use a condom or keep him from visiting commercial sex workers. In addition, there is the question of rights. Does the gov’t have the right to enforce that people get HIV testing? The Council of Europe has stated that “In the absence of curative treatment, and in view of the impossibility of imposing behaviour modifications and the impracticability of restrictive measures, compulsory screening [is] unethical, ineffective, unnecessarily intrusive, discriminatory and counter-productive.” There are a few caveats in that statement. If curative treatment is available, then is mandatory testing ethical? Just as the government can’t ‘force’ people to vaccinate their children, they can take away public goods (like free public education) if they opt not to. Is marriage and the rights guaranteed by it a public good that can be taken away if people don’t get tested? If so, what assurances can they give people that their privacy will be safeguarded? In my opinion, programs that don’t respect the rights of individuals are not the best ways to contain disease. Using the law to try to control disease spread needs to be done with a lot of care, lest there be a social backlash to the program and the disease. For HIV/AIDS, I can envision a program of mandatory counseling and voluntary testing. If this is to be successful, it also needs to come with programs to empower women to be able to get their sexual and reproductive health needs met before and in relationships.

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1 Comment

  1. lalitnarayan said,

    I fully agree with Sarah that blanket mandates cannot substitute addressing the underlying social determinants of the problem. In situations in which there is no empowerment of women, marriage often is a transfer of power from the parents to the husband.

    I do feel that laws and mandates can play an important but limited role in allowing some degree of control over the decision to enter into such unequal relationships. A comprehensive approach would be a combination of short term, immediate measures to safeguard women who are currently in such situations as well as a focus on tackling the root causes of such inequality which arise out of casteism and patriachy.

    I’m not sure mandatory counselling will work here. I currently work as an intern in one of the better hospitals in South India where pre test counselling happens probably in only 0.1% of all HIV tests. This is probably due to a combination of doctors having absolutely no training in counselling, high patient loads, very little time and the fact that culturally a lot of patients feel uncomfortable making decisions about their tests and treatment prefering to wholeheartedly (and sometimes mistakenly) trust their treating doctor instead. To create a system of counsellors for a population of over one billion would be near impossible.

    Sam/Micheal, I’m pretty excited about chancing on this blog. Its rare to find people discussing health in India on the blogosphere. I myself blog at bodypolitics.blogspot.com Could you add me as an author? My name is Lalit Narayan and my email is lalit82@gmail.com. I’ve finished my undergraduate medical studies and am three forth of the way through my internship.
    Cheers

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