Online Program

Routine HIV testing among pregnant women in India: Do the benefits justify the ethical costs?

Monday, November 4, 2013

Purnima Madhivanan, MBBS, MPH, Ph.D., Dept. of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
Karl Krupp, MPH, Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
Sean Philpott, PhD, MSBioethics, The Bioethics Program, Union Graduate College, Schenectady, NY
Celia Fisher, Ph.D., Department of Psychology, Fordham University, Bronx, NY
BACKGROUND: The Government of India has recently instituted routine HIV-testing among pregnant women attending public hospitals. METHODS: A qualitative study was conducted to understand how routine HIV-testing is being implemented. Six focus group discussions were conducted among recently-delivered HIV-negative women and healthcare workers. Twelve HIV+ women who had undergone testing during antenatal care were interviewed. RESULTS: Few participants recalled being informed about the purpose of HIV-testing. Most said their doctor informed them to test if they wished to deliver at a hospital. Only three recalled signing a consent form. Most said they were given papers and told to sign. None could remember hearing they had a right to ‘opt-out' of HIV-testing. Most said husbands/relatives were told their HIV-status before or at the time they learned. Several HIV-positive women said they were told within earshot of other patients. While most HIV+ participants reported receiving post-test counseling, several said hospital workers simply directed them to an ARV Center. Healthcare workers demonstrated sufficient knowledge about HIV testing but many disparaged women attending ANC. Several said ‘uneducated villagers' were unable to comprehend what they were told and there was no purpose in explaining. Many admitted there were occasions when others at the hospital learned a women's HIV-status. CONCLUSIONS: Women are poorly informed about the reasons for HIV-testing. Most do not undergo an informed-consent process or are told they can opt-out of HIV-testing. Counseling following HIV-testing varies widely. Healthcare workers need further training on HIV counseling, confidentiality, informed consent, and the need for non-stigmatizing HIV-testing.

Learning Areas:

Ethics, professional and legal requirements
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Analyze the effect of new HIV testing policy for pregnant women in public hospitals in India

Keyword(s): International Reproductive Health, India

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-investigator on various grants focusing on the reproductive health issues of women in disadvantaged communities and international setting. My area of interest has been to identify gaps and develop interventions to increase better health care delivery for women.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.