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new local regulation enforcing mandatory premarital HIV testing has just been endorsed by the Bogor city mayor, Bima Arya Sugiarto. It requires couples who wish to marry to conduct HIV tests to be able to gain their marriage certificates. This regulation comes in the wake of increasing cases of HIV and AIDS in Bogor.

Two kinds of HIV testing procedures are approved by the Health Ministry: voluntary counseling and testing and health provider-initiated testing and counseling. Both procedures include counseling and are not mandatory. For the latter service, one can decline to take the offered HIV test. Mandatory premarital HIV testing in Bogor will be the first regulation in Indonesia that obliges people to undergo HIV testing.

Mandatory premarital HIV testing has become a controversial requirement for issuing a marriage certificate in many countries, including in Southeast Asia, such as Malaysia and Cambodia. The proponents believe that mandatory HIV testing will protect those who are not yet infected with HIV from their potentially infected partners. Mandatory premarital HIV testing is also hoped to reduce the number of people who engage in risky sexual behavior by indirectly promoting sexual abstinence before marriage.

Critics cite human rights concerns such as infringement of the right to privacy, the right to marry and to establish a family. Other critics link the regulation to poor public health consequences, such as a false sense of security among the bridal candidates if they test negative for HIV. An HIV test result is only relevant when the test is conducted. Moreover, a person who gets a negative HIV test result today can still get infected in the future, should he or she engage in unprotected sex with someone infected with HIV or has an unknown status. This false sense of security, combined with ignorance, will make people more vulnerable to HIV infection.

Another problem is that in many countries, including Indonesia, HIV and AIDS and the people affected are still subject to stigma and discrimination. Mandatory premarital HIV testing will result in people avoiding the test, as well as preventing people from disclosing their HIV status to others, including future partners, and may lead to people obtaining fake HIV status certificates or opting for non-legal or unregistered marriages. Another impact will be cancelations of marriage proposals as a result of the HIV status of one or both of the bridal candidates.

Mandatory premarital HIV testing regulations for bridal candidates potentially harm women more than men.

Firstly, if the HIV test results are negative for both bridal candidates, the bride may face difficulties in negotiating safer sex practices within marriage. This will affect her health, including her risk of contracting HIV.

Secondly, if the HIV test result of the bride is positive, then she will be more vulnerable to experience violence, discrimination and abandonment from her partner, family, workplace and wider community.

Thirdly, if the bride is positive and she is already pregnant, her vulnerability to violence increases, as risk of violence is often higher during pregnancy.

Finally, HIV-positive women who are getting married may not necessarily want to disclose their HIV status to their future husband due to fear of wedding cancelation, shame, violence and other discrimination related to her HIV status. The results of a study show that women living with HIV do not have good adherence to HIV treatment when they do not disclose their status, as they have to get their medicine in secret.

These situations are counterproductive and prevent women living with HIV from accessing and receiving necessary care, treatment and services, including prevention of mother-to-child HIV transmission.

These potential impacts of mandatory HIV testing contradict the intention of the Bogor mayor and the National HIV program, which aim to minimize new HIV infections and protect the rights and health of people living with HIV and AIDS.

Instead of introducing this regulation, more effective steps could be taken, such as promoting HIV testing among the general population (or wider community), including to young people and couples of child-rearing age, together with efforts to step up comprehensive and quality education on HIV.

The focus should rather be on increasing access to voluntary counseling and testing services for high-risk groups and the general population; promoting voluntary couple counseling; encouraging people who take voluntary tests to voluntarily disclose their HIV status to their spouses; and ensuring that bridal candidates have access to HIV care, support and treatment services, should one or both test positive for HIV.

The mandatory premarital HIV testing regulation should be changed into a regulation offering and encouraging voluntary HIV testing for bridal candidates as part of the standard procedure by the Religious Affairs Office (KUA), which issues marriage certificates for Muslims, or by HIV counselors and health providers. In this case, bridal candidates need a guarantee that their rejection of voluntary HIV testing will not influence further services provided for them.

HIV counselors must be better equipped with knowledge around gender, sexuality and violence, as well as skills in couple counseling, violence counseling and HIV disclosure counseling, to encourage people to reveal their HIV status. Access to HIV care, support and treatment services need to be improved and brought closer to the community, including referral services for HIV and AIDS-related cases of violence.