In 1998, the Supreme Court gave a very important verdict. That verdict settled a case filed by a person against a doctor and a hospital that had revealed to his fiancée and her relatives his HIV test results without his consent.
This was the time when there was strong reflection about protecting the rights of HIV positive people. What was significant was that the verdict which came at the time when the policies of the National Aids Control Organisation (NACO), like compulsory counselling before HIV test and punishment for informing the test results even to the life partner without the consent of the patient, had legal validity was in favour of the doctor.
Even when the arguments that such actions were against medical ethics and they violated the human rights of an HIV person were relevant, the court ruled that protection of the rights of an innocent girl was more important and in that sense the doctor’s action was the fulfilment of his social responsibility. The court reiterated that, as per Indian marriage law, a person who has a sexually transmitted disease did not have the right to marry unless he was cured of it.
Diseases affecting either one of a couple, and the likelihood of even the children born to them contracting them are not restricted to sexually transmitted diseases. Having knowledge before marriage about some genetic disorders, diabetes, epilepsy and acute diseases affecting heart valves that make it impossible to conceive could help to avert dissatisfaction and disappointment after marriage and, above all, the mental trauma of divorce.
But, conducting such pre-marital medical check-ups and tests to identify diseases has a lot of drawbacks. The most important disadvantage is that revealing details of diseases like HIV infection, which could cause social discrimination, will be an impediment to the protection of a person’s rights.
Then, how could we approach this problem by protecting the rights of the person with the disease and the person without it? Like guarding a person’s rights from onslaughts, attention on the health of the future generation should be important for the government. It can be said that the society is very complacent on this subject. Usually, unwanted importance is given to family, financial status, beauty, job and dowry before marriage while ignoring factors that could strengthen or shatter married life.
Today, integrated counselling and testing centres or ICTCs that conduct tests and give detailed counselling for sexually transmitted diseases like HIV are working very well across the country. Why can’t we conceive independent pre-marital counselling centres incorporating these facilities? Youth who communicate with each other over phone and internet from faraway places after engagement and decently part ways after finding each other’s deficiencies are not rare today. Why can’t such communication and talks be held in the presence of an experienced third person?
Such centres should have facilities to conduct basic medical check-up and blood tests there itself. Test results should have full privacy. As a first step, a person’s test result should be given only to him. If a person comes to know that he is HIV positive or has any other disease, in the light of previous talks, he can withdraw from the marital relationship without disclosing the matter to his partner. If a person has the confidence to reveal the matter to the person who is going to be his partner, then he could do that too.
If needed, such centres could be widely spread under the ambit of NACO. It will not be difficult to include pre-marital counselling centres as one of the many programmes implemented with the cooperation of international organisations like WHO and UNICEF to prevent the spread of HIV. Doctors with MBBS degree or postgraduates in family medicine could be posted in such centres along with a counsellor who has a sociology or MSW degree. A certificate attesting counselling in such centres could be made mandatory before marriage.
(The writer is a gynaecologist and an author)