Pre-marital Mandatory HIV testing

A high-level State government committee for Maharashtra has recommended that pre-marital HIV test should be made mandatory. The committee headed by State Health Minister Vimal Mundada, was formed late last year after a PIL (public interest litigation) was filed in the Bombay High Court asking for such a test.
The proposal could be a first if it becomes a legislation, but it is expected to face stiff opposition.
The National Aids Control Organisation (NACO) guidelines states that mandatory HIV test should not be a precondition for employment or providing healthcare, and in the case of marriage, a test can be carried out only if a partner insists on it.
Personally I think mandatory pre-marital testing is at best a myopic policy that attempts to offer a quick-fix solution that unfortunately cannot work when we are talking about a complicated issue such as HIV/AIDS. Here are some of the reasons why we should be sceptical about this idea of mandatory testing:-

1. Mandatory testing of HIV before marriage does not really serve the purpose of preventing the spread of HIV/AIDS as it does not consider extra-marital relations and pre-marital relations (that can happen after testing!) Majority of the Indian women get HIV infected from their husbands who have sexual relations outside marriage when they migrate/travel for work.

2. Mandatory testing is going to be a very costly public health strategy that is going to require the mobilisation of huge resources. Where will the funds come from this? Instead the govt. can divert these resources for advocacy and IEC (Information-Education-Communication) so that people VOLUNTARILY decide to get tested.

3. I think this issue is comparable to that of forced sterilisation that Sanjay Gandhi had undertaken in the 1970s. Clearly any compulsion of this sort (which involves intimate human behaviour) can open a racket of false certificates as there will always be people who seek the easy way out.

4. HIV testing is not simplistic diagnostic testing. Being a life-altering test there are specific protocols such as pre and post-test counselling that must be adhered to. And anyone familiar with these protocols will know that "informed consent" is a key part of testing procedure. Doesn't manadatory testing violate this aspect?

5. Further this would have the consequence of people simply going of Maharashtra to marry where such tests might not be required! So the worrying question is are we more concerned of reducing the HIV "cases"in Maharashtra rather than India or even Asia as a whole?

6. It must be noted that mandatory testing can reach those people who get their marriages registered legally; which entails that those who do not get their marriage certificates might not get the HIV test. Unfortunately it is these people who are more likely to be vulnerable to HIV/AIDS as they lack the awareness or inclination for the need for such "unnecessary paper work".

7. Another cost related aspect is that HIV tests need to be confirmed thrice across a period of time with the issue of three different techniques. ( due to the concept of 'window period') Is the govt going to bear the costs of three tests per person? Currently only about 15% of those eligible for ART are receiving it. What does the Govt. want to really know by getting people's HIV test done? Instead, they should focus of enhancing access to services for existing PLHAs. (people living with HIV/AIDS)

8. Although the govt. is providing the assurance that the HIV test results will not be misused in the job market etc. the question arises- How are they going to do this? There is no specific legal stipulation for this.

There are ample experiences about the ineffectiveness of mandatory testing from Germany, Japan, USA and Malaysia. Instead the govt. could introduce MANDATORY HIV COUNSELLING so that people are appropriately counselled about this issue and they volunteer to take the test themselves. After all, the people should also be responsible for their own health !