Issues related to compulsory pre-marital HIV/AIDS testing

Context

In July 2025, Meghalaya Health and Family Welfare Minister Majel Amparin Lyngdoh announced that the state is considering making pre-marital HIV/AIDS testing compulsory on the lines of Goa. The issue is not limited to health only, but also includes aspects like human rights, social stigma and personal freedom.

About HIV and AIDS

• HIV (Human Immunodeficiency Virus): This virus weakens the human immune system, especially by destroying CD4 cells.
• AIDS (Acquired Immunodeficiency Syndrome): This is the advanced stage of HIV in which the immune system becomes so weak that the person becomes a victim of infections and diseases.
• Treatment: Antiretroviral therapy (ART) can control HIV, reducing the virus to an undetectable level. This means that the virus is not transmitted through sexual contact.

Tests to detect HIV/AIDS

• Types:
  • ELISA: Initial test to detect HIV antibodies
  • Western blot: For confirmation
  • Rapid test: Test that gives quick results
  • PCR test: To detect viral infection
• Procedure: Counselling and consent is mandatory before the test. Its results are kept confidential.
• Law: According to the HIV and AIDS (Prohibition and Control) Act, 2017, testing without consent and violation of confidentiality is illegal.

HIV/AIDS situation in India

• Prevalence: HIV/AIDS cases in India are high in the north-eastern states (particularly Manipur, Mizoram and Meghalaya), where injection drug use and sexual contact are the main causes.
• Treatment: The National AIDS Control Organisation (NACO) provides free ART. Lakhs of people are availing this treatment across the country.
• Awareness: Social stigma and lack of awareness deprives many people from testing and treatment.
• Meghalaya and Goa: HIV cases are rising in Meghalaya due to drug use, while the proposal for mandatory testing in Goa is yet to be implemented.

Should HIV testing be made mandatory before marriage?

• Controversy: This is a sensitive issue that requires a balance between health benefits and human rights.
• Proponents: It is being considered for implementation in states like Meghalaya and Goa but it has not been implemented yet due to legal and social challenges.

Arguments for and against

• Arguments for:
  • Family safety: Mandatory testing can protect spouses and children from the spread of HIV.
  • Awareness: Testing can motivate people to know their HIV status and start treatment.
  • Social pressure: Kundali matching is common in India. Along with this, health compatibility testing can also be useful.
• Arguments against:
  • Human rights violation: Testing without consent is a violation of the HIV and AIDS Act, 2017.
  • Social stigma: Mandatory testing can increase discrimination and stigma against HIV positive individuals.
  • False results: If the window period is not observed during testing, a negative result can be misleading.
  • Violation of confidentiality: Maintaining confidentiality can be challenging, especially in rural areas.

Will it empower women ?

• Yes:
  • There have been many cases in the North-East where men marry after hiding their HIV status, affecting women and children.
  • Compulsory testing will give women the opportunity to make informed decisions about their health.
• No:
  • Empowerment will come not only from testing but from education, awareness and social support.
  • Compulsory testing may lead to social exclusion of HIV positive women.
  • Balanced approach: Empowerment requires testing as well as extensive counselling and social support.

Broader impacts

• Positive impacts:
  • Reducing HIV prevalence and linking affected individuals to treatment
  • Protecting families and future generations
• Negative impacts:
  • Increased social stigma and discrimination
  • Violation of personal freedom and privacy
  • False negative results give a false sense of security

Challenges

• Social stigma: HIV is associated with sex work or drug use, leading to social exclusion of affected individuals.
• Legal barriers: Mandatory testing may violate the HIV and AIDS Act, 2017.
• Quality of counselling: In many places, the quality of counselling is poor or nonexistent.
• Cultural barriers: In states like Meghalaya, social and religious beliefs impact condom use and awareness about HIV.
• Access: There is a lack of testing and treatment facilities in rural areas.

Way forward

• Promote voluntary testing: Voluntary testing should be encouraged instead of mandatory testing, with proper counselling and confidentiality.
• Awareness campaigns: Massive awareness campaigns should be launched to dispel misconceptions about HIV and propagate the message.
• Improve quality of counselling: There is a need to increase the number of trained counsellors and ensure their quality.
• Access to treatment: Ensure free and accessible ART for all affected individuals
• Community participation: Reducing stigma by involving HIV positive persons as role models.
• Policy reform: Formulating coordinated policies at national and regional levels that respect human rights.

Conclusion

HIV/AIDS is a complex health and social issue that cannot be resolved through mandatory testing alone. Instead, voluntary testing, proper counselling and mass awareness campaigns can address this challenge. It must be ensured that HIV positive persons get respect and support so that they can disclose their status without fear and receive treatment. With united efforts, scientific approach and community participation, the spread of HIV can be controlled and we can move towards an inclusive, stigma-free society.