Wednesday, April 19, 2006

What do Illnois, Burundi and Goa have in common?

They have all have seriously addressed the issue of mandatory pre-martial HIV testing. In Illnois and Goa’s case it was at a government level, in Burundi it was at a church level.
When it comes to individual’s rights verses the protection of society - HIVS/AIDS throws up the most challenging moral dilemmas. The slogan ‘AIDS doesn’t discriminate, do you?’ is well known and aims to remove the stigma that adds to AIDS victims suffering. This is a desirable goal but to say AIDS doesn’t discriminate is misleading.

AIDS successfully targets societies that suffer from Poverty, War, Weak leadership, Diminished women’s rights and/or Diminished Sex Education. It is such a difficult threat to tackle because it flourishes in societies that are already under threat from the aforementioned menaces. When sorrows come, they come not single spies, but in battalions. Is it possible to have success tackling AIDS without draining the swamp of these problems and is possible to reverse the momentum once it is in motion? Furthermore AIDS is becoming less of a symptom of these crises and more of a catalyst for them. The realities on the ground are not much to our liking and yet we must deal in these realities in order to combat the threat.

When you look at the numbers it soon becomes clear that prevention is easier and more effective than treatment, yet both are necessary. A key to prevention and removing the stigma of HIV/AIDS is testing. Testing is the key as individuals are unlikely to change their behaviour if they don’t know their HIV status.

-Should HIV positive people be excluded from the army?
Our western sensibilities would of course say no - AIDS does discriminate, neither should we – and yet peacekeeping forces in Cambodia and Sierra Leone have been linked to the spread of the disease in those areas. Having recognised that the military is both a ‘highly at risk group’ and ‘major spreader’ of HIV Russia and Zambia now test military recruits. Uganda's army has a "Post-Test Club" which works with soldiers to promote openness and dialogue about the disease. In Bangladesh and the Philippines HIV-positive soldiers are automatically discharged.

-AIDS is heading East
By 2010 the largest HIV/AIDS populations will be in Asia rather than Africa. India, China and Russia are the next wave of countries that will have HIV/AIDS populations that will be a critical drain on their societies. It is projected that by that year India will have a HIV/AIDS population of 20 to 25 million. Young women are the most at risk and young women are already at a disadvantage in India due to marital traditions. So should the government make HIV test mandatory for couples before marriage and would it help? It could be a start but it would have unintended consequences - it would violate privacy, stigmatise entire families and create a black market in false HIV-test results amongst other consequences. Furthermore couple that are 'in the clear' could subsequently be more at risk from infection through infidelity. The state of Goa in India has an estimated 5 million HIV positive people and the UN is urging it not to make testing compulsory for couples who want to get married and yet it still plans to make the law effective in July of this year.

Stuart notes,
Back in 1988, Illinois passed a law requiring premarital HIV testing as condition of obtaining a marriage license. This had an interesting effect: the number of marriages in Illinois dropped 14% while the marriage rates rose in the neighboring states. When the law was repealed, the number of marriages in Illinois returned to its pre-1988 level. Perhaps the governors of Goa should take note.

Success stories in the fight against AIDS are rare and sometimes disputed but Brazil seems to be the best example. In Brazil education, condom availability and free AIDS drugs brought the threat under control but what works in one particular culture and at one economic level may not work in another. Combating AIDS always ruffles feathers, Brazil abused drug patent laws to bring its problem under control. When it comes to Goa, it should make full use of UN expertise and precedents but the regional government knows the situation on the ground best and should make the informed decision that it thinks is best for its citizens.


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