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Testing waters The State Government has been toying with the idea of a law on mandatory testing before marriage

One of the primary reasons for reluctance, he says, is a lack of understanding of HIV/AIDS. “Most people do not have enough knowledge about the disease. They believe that if they have contracted the infection, they will die very quickly.”

Dr. Reynold Washington, Director, STI, HIV Care and Surveillance of the Karnataka Health Promotion Trust (KHPT), says while knowledge of HIV and of anti-retroviral therapy has improved over the years, much needs to be done yet. “Most people do not realise that life can be prolonged and that quality of life can be maintained.”

Beyond the fear of sickness and death, however, is the fear of the stigma that accompanies a positive diagnosis. Dr. V. Ravi, Head of the Department of Neurovirology and in-charge of the voluntary counselling and testing centre at NIMHANS, explains that even among caregivers, diagnosis of the infection comes with a moral judgement. “We conduct induction trainings for health care professionals working in the testing centres. I usually conduct an exercise with them where I tell them that I am HIV positive. Outwardly they express sadness and sympathy, but they all later admit that on the inside they felt that I had done something morally wrong to get the disease. There is a perception that HIV/AIDS testing is a probing into one’s moral credentials.” And there’s the added issue of not only a lack of comprehensive support systems but also a highly discriminative atmosphere to the extent that even medical professionals refuse treatment to HIV positive individuals.

In such a scenario, the State with governments of a few other States, has been toying with the idea of a law on mandatory testing before marriage. However, professionals working in the field are against compulsory testing. Asha Ramaiah of the Karnataka Network of Positive People (KNP+) points out that the system has far too many loopholes that cannot be plugged. “If Karnataka introduces the rules, for example, people can always go to a neighbouring State to get married. Also, it is possible to get false positive or false negative results. There is also the issue of the window period, when the infection cannot be detected.”

Even if all of these difficulties are tackled, says Dr. Ravi, there are always ways to falsify certificates. “As much as we hate to admit it, there will always be laboratories and doctors who will give false certificates.” From the rights perspective too, says a member of the Bangalore HIV/AIDS forum who did not wish to be named, mandatory testing is problematic because, among other things, it breaches the confidentiality of the infected person. Most marriages are fixed by the elders of the family, and if a marriage is stopped because of a positive HIV result, he explains, the community is then privy to the results. Education and awareness are, instead, the key. Thus, on the rights level, protecting infected persons’ rights and educating them on their responsibility to prevent transmission is the best method. This has already been proven in the case of Sonagachi in Kolkata, where the levels of infection dropped after female sex workers were educated about the use of condoms and so on.

Moreover, says Dr. Ravi, the image of HIV/AIDS needs to be transformed so that people realise that it is a manageable disease and do not refrain from testing because of the fear of consequences. And on a more generalised level, says Asha, a more proactive approach to sex and sexuality education is needed, so that women are no longer ignorant about not only HIV but the whole gamut of sexuality-related issues. This training, she explains, can be done at various levels, leading up to compulsory pre-marital counselling for all. Indeed, a draft bill proposed by the Lawyers Collective aims at just such an approach, placing emphasis on compulsory pre-marital counselling with testing being voluntary.

And finally, greater awareness of the infection must be built into the general public so that a discriminative atmosphere is replaced by a supportive one.

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