We analyzed the ethical and policy issues surrounding mandatory HIV testing of pregnant women in areas with high HIV prevalence rates. Through this analysis, we seek to demonstrate that a mandatory approach to testing and treatment has the potential to significantly reduce perinatal transmission of HIV and defend the view that mandatory testing is morally required if a number of conditions can be met. If such programs are to be introduced, continuing medical care, including highly active antiretroviral therapy, must be provided and pregnant women must have reasonable alternatives to compulsory testing and treatment. We propose that a liberal regime entailing abortion rights up to the point of fetal viability would satisfy these requirements. Pilot studies in the high-prevalence region of southern African countries should investigate the feasibility of this approach.

Mandatory HIV testing and treating of child-bearing women: an unnatural, illegal, and unsound approach.

Rethinking Mandatory HIV Testing During Pregnancy in Areas With High HIV Prevalence Rates: Ethical and Policy Issues

Contributing factors to the epidemic are discussed and suggestions made for its management.

AIDS in India

HIV Testing and Confidentiality: Final Report

The instrumental uses of autonomy: a review of AIDS law and policy in Europe.

This essay examines the changing role of the ethical value of autonomy in law and policy relating to AIDS in a number of European jurisdictions. In the early years of the epidemic the autonomy of infected and at-risk persons, and of social groups was promoted as a means of reducing the spread of HIV in the general population. Accordingly autonomy was deemed worthy of respect for instrumental reasons. This means-end calculation was premised on the lack of medical therapies, as well as the need to avoid discrimination in order to prevent at-risk persons from going underground as far as health care systems were concerned. In law this instrumentalisation of autonomy was reflected in a specific application of the proportionality test, i.e. to impose coercive or discriminatory measures would be disproportionate, or even inimical, to the end of reducing the spread of HIV. This was a contingent analysis, strongly informed by the state of medical knowledge at the time, as well as by the relative power of professionals, health bureaucrats and lay activists. With the introduction of effective therapies such as Highly Active Retroviral Therapy (HAART) and Zidovudine (AZT) the terms of the proportionality analysis have changed decisively. As a result, it is now more likely than before that coercive measures will be implemented.

Mandatory HIV testing and treating of child-bearing women: an unnatural, illegal, and unsound approach.

Citations

Rethinking Mandatory HIV Testing During Pregnancy in Areas With High HIV Prevalence Rates: Ethical and Policy Issues

AIDS in India

HIV Testing and Confidentiality: Final Report

The instrumental uses of autonomy: a review of AIDS law and policy in Europe.

A contingent value? The changing role of autonomy in law and policy on AIDS

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