The Meghalaya government’s consideration to introduce mandatory HIV and AIDS testing before marriage, inspired by Goa’s model, may appear to be a well-intentioned public health response.
However, this approach is deeply problematic—ethically, legally, and medically. While the government’s concern over rising HIV cases is valid, coercive policies risk doing more harm than good.
Instead of addressing the epidemic with empathy, scientific understanding, and sound public health practices, this plan risks reviving outdated models rooted in fear and stigma.
Health and Family Welfare Minister Mazel Ampareen Lyngdoh told reporters in Shillong that the idea emerged following an “alarming” overview of the HIV/AIDS situation presented by the Meghalaya AIDS Control Society (MACS), particularly in districts like East Khasi Hills, which recorded 3,432 HIV-positive cases in 2024, almost double the previous year’s count. Only 1,581 of those infected are receiving anti-retroviral therapy (ART), pointing to significant gaps in treatment access and adherence.
Minister Lyngdoh said that a Cabinet note is being prepared to explore legislation modeled after Goa’s mandatory pre-marriage HIV testing policy, claiming it will “benefit our communities.” But such a move is neither protective nor empowering—and it certainly does not benefit those living with HIV. On the contrary, it risks institutionalizing discrimination, shaming individuals, and offering society a false sense of safety.
Let us be clear: HIV is not a moral or criminal condition. It is a manageable chronic illness. With effective ART, people living with HIV can lead long, healthy lives and—critically—cannot transmit the virus to their sexual partners. This is not hopeful speculation; it is established scientific consensus. The U=U campaign (Undetectable = Untransmittable), supported by extensive global research, confirms that if a person on ART maintains an undetectable viral load, they do not transmit HIV. Public policy must reflect this reality.
In addition to ART, preventive tools like PrEP (Pre-Exposure Prophylaxis) have transformed HIV prevention globally. Since 2012, daily oral PrEP such as Truvada has helped reduce transmission, particularly among high-risk groups. But July 2025 marked a significant upgrade in HIV prevention: the World Health Organization endorsed lenacapavir, a twice-yearly injectable PrEP drug, as a breakthrough innovation. Approved by the US FDA and marketed as Yeztugo by Gilead Sciences, lenacapavir showed near-perfect protection in Phase 3 trials—99.9% of participants remained HIV-negative.
And yet, scientific advances like U=U and PrEP remain missing from Meghalaya’s public discourse. Instead, the State appears to be resorting to panic-driven policymaking that risks treating people living with HIV as vectors of disease rather than as individuals deserving of dignity, privacy, and care.
Mandatory HIV testing raises serious ethical concerns. It violates the principle of informed consent and effectively makes marriage conditional upon a medical screening. This coercive framework reinforces dangerous myths: that people with HIV are unfit for relationships, for marriage, or for family life. In a society where stigma and silence around HIV remain pervasive, this is a step in the wrong direction.
Global health agencies including UNAIDS and the World Health Organization have long discredited mandatory testing. They advocate for voluntary, confidential, and counseling-supported testing as the gold standard. Experience from other countries has shown that coercive approaches tend to drive people away from health systems, reduce testing rates, and worsen the epidemic—exactly the opposite of what any effective policy should aim for.
If Meghalaya is serious about reducing HIV transmission, it must invest in strategies that are proven to work. These include: Widespread, accessible, voluntary testing, especially in high-burden districts; Strengthening ART availability and building adherence support systems; Public awareness campaigns that explain scientific advances like U=U and PrEP; and Comprehensive sex education that normalizes testing and dismantles stigma.
Laws must be designed to protect, not punish. And HIV can be controlled—not through fear, but through facts. And the fact is: stigma kills—not HIV.
