HIV Testing During Pregnancy: A Literature and Policy Review, Open Society Institute, Public Health Program (2008)

In the wake of changes in HIV testing guidelines as they affect pregnant women, including policy changes issued by the Center for Disease Control and Prevention (which in 2006 eliminated requirements that pregnant women be counseled before HIV testing and also that consent be documented), the Open Society Institute (OSI) issued this report on its review of testing policies, the availability of research to support recent policy changes, and recommendations for HIV testing policy going forward.

While there is the general agreement that increasing HIV testing rates is an important goal, testing implicates important human rights concerns. As the WHO/UNAIDS Guidelines recognize, these concerns may be heightened for women, who “may be more likely than men to experience discrimination, violence, abandonment or ostracism when their HIV status becomes known.” To address this concern, OSI reviewed policies for HIV testing during pregnancy from 19 countries representing all UN regions, with a focus on low- and middle-income countries. The paper synthesizes the public health, ethics, law and human rights literature on HIV testing during pregnancy, and systematically reviews over 600 published and unpublished reports on these issues.

The report concluded: (1) there is a gap between policy on HIV testing of pregnant women and research literature; (2) both the policy and research literature would benefit from writers including more detailed information about the consent processes of the testing policies/models they are discussing; and (3) studies that have compared different types of models do not describe the consent processes under each policy in sufficient detail to draw any conclusions about whether there is a trade-off between consent and testing uptake.