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

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

Design and field methods for sighting surveys of cetaceans in coastal and riverine habitats

1. Dolphins and porpoises in coastal and/or riverine habitats face serious conservation threats, yet surveys of their abundance are often especially difficult due to the challenges imposed by the habitats. Because many of these species occur in developing countries, lack of resources imposes a further set of challenges. 2. We offer advice on designing and conducting line-transect surveys with a focus on sound, practical, design rather than analytical sophistication, and we attempt, where possible, to offer simple, inexpensive solutions. 3. We guide the reader through the questions of what kind of survey should be done, whether by boat or aircraft, and we discuss ways to avoid bias and increase precision. 4. Our treatment of field methods focuses especially on robust, but low-cost, approaches. We provide two case studies to illustrate the implementation of these ideas