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17 January 2011
C. Maya http://www.thehindu.com/2011/01/17/stories/2011011757290900.htm
Pre-marital HIV test proposal draws flak
Thiruvananthapuram: The State Women's Commission's proposal to the State government to consider framing laws for making pre-marital HIV testing compulsory has drawn flak from various quarters for being ‘ill-conceived and flawed.'
‘‘None can impose pre-marital HIV testing as a general policy as it should always be voluntary. Pre-marital HIV testing should be the informed choice of the persons involved and not a coercive policy,'' an NGO representative said. The National AIDS Control Organisation (NACO) clearly stated that mandatory HIV testing should not be a pre-condition for employment or for providing health care and in the case of marriage, only if a partner insisted on it.
‘‘What is the rationale behind compulsory HIV testing before marriage? Will the Government also come up with a law banning all those who tested HIV-positive from getting married? What if one partner becomes HIV positive after marriage — will the government insist on divorce? As though the social stigma suffered by HIV-positive persons is not enough, this will create a separate class of citizens," an activist working for the rights of HIV-positive persons' networks said.
Past attempts
There have been attempts in the past too, to impose compulsory HIV pre-marital testing through legislations. In the U.S., in 1987, 33 States had considered bringing a legislation for compulsory pre-marital testing. The States of Illinois and Louisiana enacted the legislation in 1988 that marriage licence will not be issued unless HIV test certificates were produced by both parties involved.
The result was that in the first six months after the legislation was enacted, there was a 22.5 per cent reduction in the issue of marriage licence in Illinois. It also turned out that the pre-marital HIV testing was the most expensive public health programme ever. During the first six months, in Illinois, eight out of 70,846 marriage applicants tested positive and the cost for the screening was 2.5 million dollars, according to reports published in the Journal of American Medical Association (JAMA) in 1989. The State of Louisiana repealed the legislation after six months of enacting it, while Illinois followed suit in 1989.
No support
JAMA pointed out that the goal of any screening programme should be to identify infected individuals so that appropriate intervention measures could be taken to prevent further spread of the disease. In the case of compulsory pre-testing, not only was the programme ineffective in identifying more infected people, it was not cost-effective and the target population did not support the programme. In India, Goa, Andhra Pradesh and Maharashtra could not enact the legislation regarding compulsory HIV testing despite the declarations of the State governments. In 2004, a meeting of Catholic bishops in Thrissur had passed a resolution that pre-marital HIV testing be made mandatory because ‘unsuspecting families needed to be protected.'
Fear of discrimination
Human rights activists pointed out that the proposed legislation was well-meaning but that in the long term, such a generalised policy could be bad for the HIV control programme itself because fear of social discrimination would force people to flee rather than come forward to declare their HIV status. The partners to be involved in a marital relationship could reach an agreement on HIV testing and volunteered to test themselves. Rights activists pointed out that given the level of corruption and manipulation in the system, it would not be very difficult for people to come up with false certificates also. There were other important questions such as who would bear the costs involved, the number of test kits and other resources that would be required.
http://www.thehindu.com/2011/01/17/stories/2011011757290900.htm
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