RE: [KeralaAIDS] Will Kerala make Pre-marital HIV test Mandatory ?

 

Dear All,

Those who have got a basic understanding about the "principles of screening tests", as well as knowledge in basics of public health, and the epidemiology of HIV in the state, will not agree with mandatory premarital HIV testing.

Before taking any decision, these questions need to be addressed:

1. What is the prevalence of HIV in Kerala among young population?
2. What is the sensitivity, specificity, and positive predictive value of the available test kits?
3. What is impact of false positive cases in the community?
4. What are the ethical issues involved?
5. What if any, are the existing regulatory mechanisms for ensuring the quality of laboratories in Kerala?
6. What is the additional cost to the society? And what is the cost-benefit ratio?

Ultimately the companies that manufacture "HIV Testing Kits" are the ultimate winners if such mandatory testing policies are put in place. In addition, it will give society a false sense of security.

These factors have to be taken into consideration before any decision. Resources must only be spent based on priority and need; and not on demand. And then, decision should come from un-biased experts and policy makers and not from funding agencies.

With Regards,

Dr. Jayakrishnan T., and Dr. Jeeja M. C.,
Medical College,
Kozhikode.

From: Dr. Ajithkumar K.
Sent: Thursday, February 03, 2011 4:31 PM
To: KeralaAIDS@yahoogroups.com
Subject: RE: [KeralaAIDS] Will Kerala make Pre-marital HIV test Mandatory ?

Dear Forum,

I have been following this thread. It is important to see this topic in much more detail. There are 2 issues here:

1. One of the most important factors that leads to HIV infection among women in Kerala is by getting married to a man who is infected with HIV.
2. Strategies like mandatory premarital testing has failed, and is not acceptable.

Still, there is a need for further discussion to search for other possibilities and options to address the first issue I have listed above. I feel it is important to sensitise the pre-marital young men and encourage them for voluntary testing. We should modify our IEC strategy to target young premarital young men especially the returning migrants, who had sexual encounters outside Kerala. This will enable both early detection of HIV infection and also facilitate prevention to partners.

I request a discussion on this topic through this forum.

With regards,

Dr. Ajithkumar K.,
Medical College Hospital,
MG Kavu, Thrissur.

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From: Media Monitor
Sent: Monday, January 24, 2011 6:41 PM
To: KeralaAIDS@yahoogroups.com
Subject: [KeralaAIDS] Mandatory Pre-marital HIV Test Proposal Draws Flak

 

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 © Copyright The Hindu

 

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