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NEWS: Peter Moszynski Rwanda denies plan to forcibly sterilise people with learning difficulties BMJ 2009; 339: b2712 [Full text]

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The need for mandatory premarital HIV testing

Rupert A Gude   (26 July 2009)

The need for mandatory premarital HIV testing 26 July 2009
Rupert A Gude, VSO Doctor Kagondo hospital, Kagera, Tanzania Send response to journal: Re: The need for mandatory premarital HIV testing	I have no support for forced sterilisation. However Human Rights Watch is misguided in its attitude that mandatory premarital HIV tests will not help the fight against HIV. The position of women in Subsaharan Africa is one of severe gender imbalance. In poor rural communities young girls are often married off to older men as a means of economic survival for a family (gain bride price and possible support from the wealthier older husband). The HIV prevalence in Tanzania shows a prevalence inequality of about 5 years, ie the rate in men is reflected in women 5 years younger than them. Older men tend to infect their younger brides. Prevalence of HIV % (1) Age........Female....Male 15-19.......1.3......1.0 20-24.......6.3......4.3 25-29.......7.9......6.7 30-34......10.4......9.1 35-39.......9.5.....10.0 In our region it is common for a man to divorce a wife who is found to be HIV positive at the antenatal clinic. This means that over a half of newly diagnosed antenatal mothers do not register at the Care and Treatment Centre as they do not wish to divulge their status to their husband. This denies them the chance for effective monitoring and possible treatment. It also makes our Preventing Maternal To Child Transmission (PMTCT) programme more difficult to implement. Even if they do disclose, the majority of husbands refuse to be tested. More commonly they divorce their wife and take a younger bride who will be infected in turn. It is precisely to avoid this, that mandatory premarital testing should be instituted especially as divorced men have 3 times the national prevalence. It would be unreasonable to pick elderly divorced men as a group so testing should be done for all those who intend to be married. Ideally it should be done at the same time so that there is no room for fraudulent certificates. Human Rights Watch should be wary of imposing on African communities ethical guidelines about HIV testing that are worked out for western communities. In Africa there is often a severe lack of basic human rights for many women in their relationship with men and a real risk of fraud. Rupert Gude (1) Tanzania Health and Malaria Indicator Survey 2007/08 Competing interests: None declared