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Global Health Policy Blog


When Bill Clinton says something about anything, people listen. So the former President's recent endorsement of mandatory HIV testing and even compulsory disclosure in high prevalence countries has, without a doubt, fuelled the ongoing debate about mandatory vs. opt-out testing. A recent article in the Financial Times highlights some of the arguments and outlines Clinton's justification for his support of mandatory testing:

Asked about the ethics of such compulsion, he argued that it could be justified in countries with high infection rates, on condition there was guaranteed diagnosis, treatment and anti-discrimination measures put in place."In a population with extremely high rates of infection, (mandatory testing) overcomes other reservations," he said, warning of the "social wreckage" devastating poorer countries with widespread HIV incidence.

What about the potential "social wreckage" caused by mandatory policies endorsed by powerful global donors and leaders like Clinton? Despite his best efforts to reduce the price of drugs, how can Clinton conceive of guaranteed treatment when barely a third of the people who need ARVs in the developing world are receiving them? How does one guarantee diagnosis, when testing kits may not always be available and most importantly, how does one provide or obtain a guarantee for the enforcement of anti-discrimination measures? With all due respect to Clinton for all his efforts to stall the HIV/AIDS pandemic, a powerful donor's public endorsement of a mandatory testing measure can swing the debate in a direction that perhaps coerces country governments to adopt such a policy, or perhaps legitimizes governments' decisions to introduce coercive measures. In reality though, donors will unlikely be able to keep their side of the deal and even worse governments may enforce coercive policies on their citizens, without being able to deliver the treatment and anti-discrimination measures that they have "promised." One doesn't have to look too far back to see a how a policy endorsed by global heavy weights can play out in the real world. Consider the controversial issue of female sterilization in India's pre-1994 National Family Planning Program, developed in response to and justified by a global donor driven agenda to contain population growth, and you may shudder because women were coerced in to sterilization in large numbers for years, and it wasn't even a mandatory policy!

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CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.