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HIV test and marriage

the Indian government clearly mandates voluntary testing as the appropriate public health strategy, writes Dr KK Aggarwal.
By Dr KK Aggarwal | PTI, New Delhi
UPDATED ON JUL 26, 2005 06:15 PM IST

The National AIDS Prevention & Control Policy of the Indian government clearly mandates voluntary testing as the appropriate public health strategy in dealing with HIV/AIDS.

On the other hand there have been opposing views expressed at the governmental level in other parts of the country particularly favouring mandatory pre-marital testing for HIV. These have been voiced recently in the Goa legislature and by the Andhra Pradesh legislature. We hereby enlist the PRONS and CRONS against this argument.

FOR 

HIV spreads by the mixing of the internal secretions with the HIV positive internal secretions of the other person. Internal secretions are blood and its products, sexual secretions, internal body secretions like pleural, brain, peritoneal or placental fluids. When blood testing is mandatory before it is given from one person to the other then why internal secretions are not tested when they ate allowed to be given from one person to another. The risk in blood transfusion is only once but in the case of internal secretions (sexual route) it will be again and again.

In a move bound to elicit unprecedented protests, the Pentecostal Assemblies of Zimbabwe, a grouping of 150 Pentecostal and evangelical churches, has already embarked on a historic fight against HIV/AIDS by introducing mandatory testing for all its pastors, marriage officers and would-be couples.

On January 13, 2004, India's Roman Catholic bishops asked the government to make HIV and AIDS tests compulsory before granting marriage licenses to help prevent the spread of the deadly disease. Because of the increasing cases of AIDS cases in India, the church feels that priests should be convinced of the health status of couples before solemnizing their marriage.

A policy to mandatory test couples before marriage could protect the prospective spouses of persons living with HIV from acquiring the disease.

In general population 0.2 to 0.75% people are HIV positive. This is a significant number. (TB 1%, asthma 1%, and cancer 1%).

Public wants it. In one of the NDTV poll survey the results were 73% in favour of the testing.

In general population 0.2 to 0.7% people are positive for HIV, 1-2% are positive for hepatitis B surface antigen, 4-11% are positive for Hepatitis B Core antibodies and 5% for hepatitis c antibodies. The question therefore should not be HIV testing or not. It should be how safe the partner is and should involucel a series of tests which can be transmitted via sexual route,

In South Africa, the country with the largest number of persons infected with HIV, statistics suggest that 50% of youth under the age of 15 are expected to die of Aids before they are 40, that 14 000 contract the virus each day and that five to 9 million people have HIV/AIDS. Also 95% of people worldwide who are infected with the virus are not aware of it.

In France, people are required to test for syphilis, toxoplasma and blood type before marriage.

If not than why all over the world people are required by law to be vaccinated. Why before getting job institutions ask for chest X-rays to exclude TB. Why testing for becoming a commercial driver pr a pilot? Why testing before joining military job? Why HIV test for immigration to many countries?

AGAINST

The most common way of testing for HIV is through an antibody test. However, the peculiarity of an HIV antibody test is the "window period". The "window period" is one in which even though a person is infected with HIV, s/he would be tested negative as her/his antibodies are not developed. Therefore, even though a person is infected with HIV, s/he will test HIV negative. Therefore, a single antibody test for HIV does not serve the purpose of preventing the prospective spouse from getting infected. Therefore, mandatory testing would not result in achieving the objective sought to be achieved.

It may also be noted that there is also a high rate of false positive results in the country and persons may not actually be infected. Thus, in view of the stigma surrounding HIV, a person who is actually not HIV positive could be marred for life on account of a false positive result and may not be able to marry at all. This would have a traumatic effect on her/ his life and on her/his family.

Mandatory testing for HIV prior to marriage would only give the state a false sense of security.

A pre-marital HIV mandatory test does not prevent persons from getting infected after marriage, and thereby putting the spouse at the risk of getting infected.

Mandatory testing would only drive the disease underground.

This may initiate people going outside the State to marry, where such tests are not required.

Mandatory testing often ignores issues of consent and confidentiality of a person's HIV status.

Mandatory testing could also open a racket of issuance of false certificates prior to marriage. It would also add cost.

In Hindu marriage can be solemnized only by performing ceremonies. No registration is required. Therefore, a policy for mandatory testing would be impossible to implement.

The American Civil Liberties Union Report of March 1998 reported that mandatory pre-marital HIV testing was a record of failure. It stated that more than 30 states in the USA considered pre-marital HIV testing. However, all the states except for Illinois and Louisiana rejected the idea (source lawyers collective).

(The writer is a senior Physician, Head Department of Cardiology and Deputy Dean Board of Medical Education-Moolchand Hospital, President-Heart Care Foundation of India, President Delhi Medical Association and Member-Delhi Medical Council.)

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