Rwanda denies plan to forcibly sterilise people with learning difficultiesBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2712 (Published 06 July 2009) Cite this as: BMJ 2009;339:b2712
All rapid responses
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)
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
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.
(1) Tanzania Health and Malaria Indicator Survey 2007/08
Competing interests: No competing interests