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ETHICS OF MANDATORY PREMARITAL HIV TESTING IN AFRICA: THE CASE OF GOMA, DEMOCRATIC REPUBLIC OF CONGO

Authors

  • STUART RENNIE,

    Corresponding author
    1. Departments of Dental Ecology and Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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  • BAVON MUPENDA

    Corresponding author
    1. Centre Interdisciplinaire de Bioéthique pour l'Afrique Francophone/Interdisciplinary Bioethics Center for Francophone Africa (CIBAF), Ecole de Santé Publique/Kinshasa School of Public Health, Kinshasa
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Stuart Rennie, Departments of Dental Ecology and Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7450, USA. stuart_rennie@dentistry.unc.edu; Bavon Mupenda, Centre Interdisciplinaire de Bioéthique pour l'Afrique Francophone/Interdisciplinary Bioethics Center for Francophone Africa (CIBAF), Ecole de Santé Publique/Kinshasa School of Public Health, Kinshasa, BP 11850, Democratic Republic of Congo. bavonmupenda@yahoo.co.uk

ABSTRACT

Despite decades of prevention efforts, millions of persons worldwide continue to become infected by the human immunodeficiency virus (HIV) every year. This urgent problem of global epidemic control has recently lead to significant changes in HIV testing policies. Provider-initiated approaches to HIV testing have been embraced by the Centers for Disease Control and Prevention and the World Health Organization, such as those that routinely inform persons that they will be tested for HIV unless they explicitly refuse (‘opt out’). While these policies appear to increase uptake of testing, they raise a number of ethical concerns that have been debated in journals and at international AIDS conferences. However, one special form of ‘provider-initiated’ testing is being practiced and promoted in various parts of the world, and has advocates within international health agencies, but has received little attention in the bioethical literature: mandatory premarital HIV testing. This article analyses some of the key ethical issues related to mandatory premarital HIV testing in resource-poor settings with generalized HIV epidemics. We will first briefly mention some mandatory HIV premarital testing proposals, policies and practices worldwide, and offer a number of conceptual and factual distinctions to help distinguish different types of mandatory testing policies. Using premarital testing in Goma (Democratic Republic of Congo) as a point of departure, we will use influential public health ethics principles to evaluate different forms of mandatory testing. We conclude by making concrete recommendations concerning the place of mandatory premarital testing in the struggle against HIV/AIDS.

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