Practical problems

Testing pregnant women for HIV regardless of their consent involves ethical and legal issues.

Testing pregnant women for HIV regardless of their consent involves ethical and legal issues. In developed countries it is voluntary. The test, made mandatory for pregnant women in India in 2009, was never implemented on the scale required. Now, to simplify the process the government has amended the guidelines by making verbal consent sufficient for screening pregnant women's HIV status. Instead of giving impetus to awareness programmes and preventive measures to check HIV/ AIDS, taking human rights of the female population for a ride, which has barely 65 per cent literacy rate, cannot be applauded unreservedly even if backed by the good intent of reducing occurrence of HIV in the newborn. 

A mandatory approach to testing has the potential to significantly reduce the prenatal transmission of HIV, but will the government mandate other conditions like continuing medical care, including antiretroviral therapy for the HIV-positive pregnant women and their rehabilitation? Will the government support a liberal regime entailing abortion rights up to the point of viability, if the woman so wants? Will it not complicate the existing guidelines of the PCPNDT Act in case of a female foetus? The mandate complicates issues more than it seeks to solve. 

False positive tests are not uncommon even in developed countries. Confidentiality is often violated and the stigma against HIV remains high in India. In a survey 97 per cent Indian women had voiced concerns against an HIV test, citing stigma as the main cause. Poverty and poor access to clinics are other issues that cannot be wished away by making the test mandatory. In Ivory Coast, fewer than 50 per cent of HIV-positive pregnant women returned to receive treatment for fear of their child being shunned by society. With an army of trained auxiliary nurses and midwives, panchayat registers fail to show an exact number of pregnancies till the past first trimester when the sex of a foetus can be ascertained. It’s highly unlikely the same apparatus will show HIV status of pregnancies. The government should rethink this amendment.

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