Prenatal HIV Testing Must Respect Women’s Rights

New York City (June 27, 2009) - Tomorrow is National HIV Testing Day. Pregnant women with HIV routinely find their human and civil rights sacrificed in the name of the health of the fetuses they carry. Prenatal HIV testing raises a unique debate about the perceived tension between the rights of the mother and the health of the unborn child.

“Perinatal HIV transmission is at an all-time low. States now have an opportunity to commit to positive health outcomes for mothers and children while respecting basic principles of consent for HIV testing,” says HIV Law Project’s Deputy Executive Director, Cynthia B. Knox. This can be done by promoting testing schemas that universally counsel pregnant women about HIV, and encourage all women to be tested, while affirmatively seeking a woman’s consent before testing. Falling short of this standard risks undue trauma for the pregnant woman upon diagnosis, as well as the alienation of the woman from her health care provider.

It should not be surprising that the vast majority of pregnant women who are offered an HIV test accept testing. One study found that when offered an HIV test, more than 86 percent of women agreed to be tested. And for those who did not test, typically declined because they didn’t think they were at risk, they encountered administrative or scheduling hurdles to testing, they had tested previously, or they did not believe their provider thought it was important for them to test. Proper counseling and administrative corrections, therefore, would increase testing rates to nearly 100%. Meanwhile, compelling HIV testing runs the risk of alienating patients from their medical care provider, and in turn driving them from care.

And while it is true that the vast majority of women will accept HIV testing, it is also true that a small minority of women will likely decline testing for fear of the results. Says Ms. Knox: “A woman experiencing intimate partner violence might well fear that an HIV diagnosis would trigger an escalation of violence. Another woman may fear that she’ll lose her job if she has HIV. Others may fear isolation from her family or community.” For the small minority of women who are reluctant to test, coercion and/or poor communication are neither appropriate nor effective bases upon which to build a provider-patient relationship, or to begin the process of long-term care and treatment.

While this prescription may seem to place unreasonable demands on health care providers, it is the only way to ensure that women who test positive do not abandon the health care system. Alison Yager, Project Manager at HIV Law Project’s Center for Women & HIV Advocacy says: “If in our haste to boost testing rates we sacrifice the pregnant woman’s participation in the process, or her trust in her provider, we risk alienating her from the health care system.” If this happens, then we are no closer to our goal of reducing mother to child transmission.

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