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eBook details

• Title: Evaluating the Right to Autonomy Argument in the Debate on Coercive Antenatal HIV Testing in South Africa (Report)
• Author : South African Journal of Bioethics and Law
• Release Date : January 01, 2010
• Genre: Law,Books,Professional & Technical,
• Pages : * pages
• Size : 273 KB

Description

About a third of pregnant women in South Africa (SA) are thought to be HIV infected, and HIV/AIDS is said to be the leading contributor to under-5 mortality (57%). (1) The country has approximately 280 000 children (ages 0 - 14) living with HIV, (2) and the vertical HIV transmission rate is thought to be about 25%. (3) SA's prevention of mother-to-child transmission (PMTCT) of HIV programme has been described as key to the survival of the country's women and children, as it is thought that up-scaling PMTCT services (along with improved infant feeding) could save about 37 200 children annually. (4) One challenge for the PMTCT programme, however, is the unsatisfactory uptake of HIV testing by pregnant women. Under SA's voluntary HIV testing policy, only about half of the 80% of pregnant women who have access to the PMTCT programme accept HIV testing, meaning that only about a third of HIV-infected women receive appropriate prophylactic antiretrovirals to prevent vertical transmission of IV. (5) To address the challenge of poor uptake, coercive HIV testing of pregnant women in areas of high HIV prevalence such as SA, with functioning PMTCT programmes, has been suggested. (6,7) Some favour mandatory testing policies where HIV testing is required as part of routine antenatal care services, while others support a system of routine testing under which the woman automatically gets tested unless she opts out of the testing. These proposals are supported by some evidence suggesting that coercive testing, in particular routine HIV testing, can increase PMTCT uptake. A recent paper, for example, concludes that Botswana's 'shift to routine HIV testing resulted in a dramatic increase in testing and in PMTCT service delivery without measurable adverse effects', giving it the highest current uptake of any PMTCT programme in Africa. (8) These approaches may, however, be regarded as coercive (or liberty limiting) as they both lack emphasis on extensive counselling and informed consent procedures before HIV testing. As such they are not deemed sufficiently voluntary by some, including the Health Professions Council of South Africa and the South African Medical Association. (9)

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