Sarita knew nothing about HIV/AIDS until her husband tested positive. A few months later, she and her elder daughter also tested positive. This was four years ago. Her husband died in 2002.
Life has taught her many bitter lessons: It has taught her that women cannot negotiate safe sex due to their disadvantaged position in society as well as due to lack of personal power. "Women in fact are more at risk of getting infected from their partner because of their vulnerability," she says.
Yet, she doesn't support the Goa government's decision to make HIV/AIDS testing mandatory before marriage. Sarita (name changed) believes that awareness and counseling - not mandatory pre-marital testing - are the need of the hour. The government needs to impart information, educate people and counsel women about HIV when they are adolescents, thereby helping them to protect themselves from getting infected.
Despite opposition from people living with HIV and activists working with HIV+ persons, the state government has decided to go ahead with its proposed plan to make HIV/AIDS testing mandatory before marriage. Health Minister Dayanand Narvekar maintains that the decision has been taken in the interest of the people. If passed in the state legislature, Goa will be the first state in the country to implement this law.
The National AIDS Control Organisation's (NACO) policy on testing is very clear. It encourages voluntary testing after counseling as the appropriate public health strategy in dealing with HIV/AIDS. Dr Denis Broun, Country Director, UNAIDS (United Nations AIDS programme) maintains, "You can curb the disease only by spreading information, counseling and convincing families to go for HIV testing before marriage. The government shouldn't interfere and introduce mandatory testing before marriage."
Even the Roman Catholic Church in Goa has opposed the move. Besides issuing a public statement opposing the proposed law, it has sent letters to members of the legislative assembly and ministers dissuading them from supporting a legislation that would affect human freedom and dignity. "Any legislation in this regard, apparently for the so-called well-being or for the utility of any single individual citizen or citizens in general, must be just, acceptable and respectable," said Fr Socorro Mendes, Director, Family Service Centre, Archdiocese of Goa.
However, the state health authorities argue that HIV affects people primarily when they are most productive and leads to premature death, thereby severely affecting the socio-economic structure of whole families and communities. "A majority of women infected with HIV/AIDS in Goa are in the age group of 15 to 35," said an official from the health department, on condition of anonymity.
Officials at the Goa State AIDS Control Society (GSACS) are tight-lipped about the issue as they find themselves sandwiched between the state government policy and that of NACO on HIV/AIDS.
Meanwhile, non-governmental organisations (NGOs) working with people living with HIV believe that such a proposal will have a harmful impact on the state's efforts to contain HIV/AIDS as it is based neither on sound public health policy nor on human rights principles. "It is going to be a disaster in the end. In Goa, there is no clinching evidence to suggest that a woman is infected during marriage. In fact, the 2005 Sentinel Survey for Goa shows that none were infected in the antenatal setting, a marker for mainstream women," said Anand Grover, Director, Lawyers Collective HIV/AIDS Unit.
Activists say that they are opposed to the state government's decision because it may create an alarm and drive the disease underground and give the state a false sense of security that the infection is being effectively prevented from spreading. They also fear that this would also lead to the issuance of false certificates prior to marriage, thereby having a negative impact on the entire public health system. Besides, the strategy also does not take into account a large number of young people having sex at the pre-marital stage or post-marriage stages, which can lead to the infection, they added.
Dr Eugene D'Silva, a gynecologist, said that pre-marital testing does not prevent persons from getting infected after marriage. "What about people who are tested during the window period? During the window period even if a person is infected, they would be tested negative, as the antibodies are not developed", he noted.
"The plan to introduce mandatory pre-marital HIV testing is not based on any scientific study. Any programme for prevention or intervention has to be based on concrete scientific studies so that it helps contain the disease. HIV mandatory testing has only proved to be counter-productive," said Beethoven Fonseca, who works with Positive People, an NGO.
Interestingly, pre-marital testing is not something new. It has been tried at other places and failed. The American Civil Liberties Union Report of March 1998 reported that mandatory pre-marital HIV testing was a 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. Illinois and Louisiana enacted and enforced mandatory pre-marital testing, but subsequently repealed them.
Can the Goa government hope to succeed where others have failed?