In an attempt to lower HIV rates, the Indian state of Maharashtra introduced [1] a controversial proposal earlier this year, which would make it compulsory for couples to undergo an HIV test before getting married. Similar bills have been proposed in other Indian states, such as Karnataka, Goa, and Andhra Pradesh.
The proposed bill adds fuel to an ongoing debate in India about whether mandatory pre-marital HIV testing is an effective prevention strategy. HIV rates in India skyrocketed in the 1990’s and today it's estimated [2] that around 2.5 million Indians are living with HIV. Despite these numbers, the National AIDS Control Organization (NACO) [3] encourages voluntary HIV testing, rather than compulsory testing.
blog.bioethics.net points out [4] that such a policy will create a number of new issues for India to address.
“Will the mandatory testing policy create a new stigmatized underclass? How would the policy protect women in India, when many of them end up being infected after marriage by unfaithful spouses? Will HIV positive persons start gravitating towards other HIV positive persons as their only likely marriage partners (a form of what is known as ‘serosorting’)?”
Bobby Ramakant of Citizen News Service argues [5] that this kind of policy infringes on a person's right to privacy and doesn't address the stigma and discrimination that follow an HIV diagnosis. The policy may also be counter-productive, since an HIV test alone won't necessarily lead to the behavioral changes needed to lower HIV transmission rates.
“The paramount progress we have made in terms of NOT thinking about prevention and treatment in isolation is at risk to be lost with Indian states promoting HIV prevention strategies completely ignoring the treatment, care and support provisions for people living with HIV.”
Queer India goes a step further [6], calling the idea absurd.
“A crazy idea doesn’t take time to take root in a climate of fear and ignorance, a climate where even talking about safer sex is shameful.”
Reason for Liberty also opposes mandatory testing [7], but says that voluntary testing can be beneficial, especially since HIV has now made its way into India's middle class. Voluntary pre-martial HIV testing may be one of the solutions, along with legalizing prostitution and talking more openly about sex, to help lower HIV rates in India.
“Despite all shaggy faiths and belief system, it is highly improbable to shut eyes and accept that Indian middle class is safe. In reality I feel that the middle class is more vulnerable to HIV then others. When middle class people can stress on horoscope matching [for a marriage match], why cannot they accept pre-marital HIV testing?”
Mahima, however, supports compulsory testing and says [8] that the real question is what is the implication of such a test?
“The authority that has these results in its hand, in this case the state government, can one trust it enough to be sure this won’t be the beginning of a HIV-cleansing (if you will). But if we are being hypothetical, then why not consider that the mere existence of this test might encourage younger people- even married couples – (if its made compulsory every couple of years) to behave responsibly. Because ultimately, for the most part this is a behavioral disease and with adequate precaution, can be totally avoided.”
Sakshi summarizes [9] both sides of the debate. Though her initial response to the question of mandatory HIV testing was yes, she now sits on the fence.
“What it all boils down to is – premarital HIV test allows for a RIGHT to a safe happy life that a couple can choose to take. However, our own pre-conceived notions about the disease, our family’s discomfort and our society’s mental block may stop many of us from taking up this right. But at times, something as insignificant as our pre-conceived notions can end up being a matter of life and death.
And therefore I believe it’s simply question of one’s right. What about you?”
Photo of Maharashtra Painting of Bride [10] by yashrg [11] on Flickr.