Sunday, April 01, 2007

Mandatory HIV testing: What's the objective?

In recent months, a few State Governments in India, for example Andhra Pradesh and Goa, have put forward proposals to mandate HIV screening for couples prior to marriage. Let us first consider the objectives behind such legislation and then we can discuss whether a) it achieves the stated objective, and b) it marks a major step by government officials towards curbing the alarming spread of HIV/AIDS in India.

Andhra Pradesh officials have stated that such screenings are necessary to curb the chances of HIV positive parents passing on the virus to their children. Identification of prospective parents who are HIV positive, would help to initiate preventive measures to prevent transferring the virus from mother to child. Another key reason is to inform individuals about the HIV status of their prospective spouses.

On the face of it, both of these are commendable and necessary goals for State governments. Awareness and knowledge can lead to safe preventive practices that can guard against the spread of the virus. However, mandatory HIV screening before marriage comes across as a half-baked idea that was rushed forward in the public to demonstrate that the State governments are actively trying to address the massive spread of HIV in India.

Let's consider this before discussing further...married women in monogamous relationships are a prime risk group for HIV/AIDS in India. And while I don't have the statistics on hand at the moment, I think it is safe to assume that not all their spouses were HIV positive before or at the time of marriage.

How can mandatory HIV screenings prior to marriage prevent HIV transfers once into the marriage? Stigma and discrimination in the case of HIV/AIDS are very high in India. It is still a male-dominated patriarchal society where a majority of women still do not have the social privilege, the self-efficacy, and the social safety net (in case of negative repercussions) to challenge their husbands. Will they be able to demand ongoing screenings, regular condom usage, and legal action for being infected by their husbands? And although I have argued solely from the womens' perspective, we have to admit men might face the same problems with their partners.

And India also suffers from a lack of awareness, ignorance, misconceptions, and...yes of course...stigma and the taboo factor.

Does this mean mandatory screenings for couples or individuals are completely useless? Maybe not...maybe regular mandatory screenings might really help in curbing the spread of the virus. This then raises major ethical concerns...shouldn't my health information remain completely confidential? But then, on the other side of the debate, don't I have the right to know about threats to my health and life? The ethics and confidentiality angle is something that has to be carefully considered in designing policies...

In addition, we know that finding the sex of a foetus and abortions of female foetuses occur all across the country with all the laws in place. How do we ensure that screening records will not be changed through bribes and forged?

Similarly, how do we ensure that screening records are not used unfairly against people with HIV/AIDS...for example to fire them (Philadelphia anyone?), not hire them, smear them in public, blackmail them etc. etc.

Questions, questions...and no solid answers. That's because this is not an issue that has a quick-fix solution nor does it have a "one-size-fits-all" solution. This needs careful discussion and debate. Government officials anxious to "do something" need to consider all sides of the issue. They need to prioritize this problem, and understand it's magnitude and realize that there are a number of reasons that result in the spread of the HIV virus. They have to take into account India's cultural setting.

Even when their hearts are in the right place (which seems to be the case here) rushing into a solution...any solution...will not pay off. I am glad they are doing something...but in this case, anything is not good enough.