HIV testing in pregnancy: Using women's voices to inform policy

Bulman, Donna; Mathews, Maria; Parsons, Karen; O’Byrne, Nicole C.

doi:10.1016/j.wombi.2012.08.004

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…The universal "opting out" testing of all pregnant women has proved to be superior to the voluntary "opting in" testing and counselling in identifying more HIV-positive pregnant women and bringing them into care (25). However, Field and Kaplan (26) and Bulman et al (27) have cautioned that the opting out approach may raise ethical concerns if women's informed consent is violated, as the increase in the rate of testing is achieved at the expense of women's knowledge that the test is optional (26) and marginalizing their right to refuse (27). Although voluntary testing was the preference of nearly two-thirds of women enrolled in this study, more than three-quarters of them accepted the routine testing of all pregnant women initiated by the Public Health Directorate at the Ministry of Health in Oman.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitudes and intended behaviours towards HIV testing and self-protection: a survey of Omani pregnant women

Al-Jabri

Youssef

Hasson

et al. 2014

East Mediterr Health J

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Routine HIV testing of all pregnant women in Oman has been introduced without prior knowledge of women's attitudes towards testing or their behaviour in the event of a positive test. This study recruited 1000 Omani pregnant women from antenatal clinics to explore their knowledge of HIV/AIDS, attitudes towards HIV testing and intended behaviours in the event of a positive test. Mother-to-child transmission was recognized by 86.6% of the women but only 21.0% knew that it was preventable and a few acknowledged the important role of antiviral drugs. Half of the women (51.9%) reported having been tested for HIV and 75.8% agreed about routine HIV testing for all pregnant women. A higher level of knowledge was significantly associated with a favourable intended behaviour related to voluntary testing, disclosure and seeking professional assistance in the event of a positive HIV test. The results are discussed in relation to opt-in and opt-out approaches to voluntary testing during pregnancy. ‫ن‬

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Section: Discussionmentioning

confidence: 99%

Knowledge, attitudes and intended behaviours towards HIV testing and self-protection: a survey of Omani pregnant women

Al-Jabri

Youssef

Hasson

et al. 2014

East Mediterr Health J

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“…However, routine opt-out testing protocols may compromise the counselling and consent process [ 107 ]; limiting pre-test counselling to convey the potential legal implications of a positive result, and removing the opportunity to refuse testing or request anonymous testing [ 108 – 111 ]. In qualitative interviews exploring experiences of opt-out antenatal HIV testing among 12 pregnant women in Newfoundland and Labrador, no participants were advised they had the right to refuse HIV testing, and some participants were tested for HIV without providing formal consent or being aware that they were being tested [ 112 ]. This qualitative study raised concerns that an opt-out approach to testing may threaten provider trust, and affect future health seeking behaviour [ 112 ].…”

Section: Resultsmentioning

confidence: 99%

“…In qualitative interviews exploring experiences of opt-out antenatal HIV testing among 12 pregnant women in Newfoundland and Labrador, no participants were advised they had the right to refuse HIV testing, and some participants were tested for HIV without providing formal consent or being aware that they were being tested [ 112 ]. This qualitative study raised concerns that an opt-out approach to testing may threaten provider trust, and affect future health seeking behaviour [ 112 ]. Similarly, in a survey administered to 299 postpartum women in Toronto, 74% of participants reported receiving pre-test counselling before antenatal HIV testing, and 70% of these participants were given the option to refuse the test [ 113 ].…”

Section: Resultsmentioning

confidence: 99%

The impact of criminalization of HIV non‐disclosure on the healthcare engagement of women living with HIV in Canada: a comprehensive review of the evidence

Patterson

Milloy

Greene

et al. 2015

Journal of the International AIDS Society

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IntroductionIn 2012, the Supreme Court of Canada ruled that people living with HIV (PLWH) must disclose their HIV status to sexual partners prior to sexual activity that poses a “realistic possibility” of HIV transmission for consent to sex to be valid. The Supreme Court deemed that the duty to disclose could be averted if a person living with HIV both uses a condom and has a low plasma HIV-1 RNA viral load during vaginal sex. This is one of the strictest legal standards criminalizing HIV non-disclosure worldwide and has resulted in a high rate of prosecutions of PLWH in Canada. Public health advocates argue that the overly broad use of the criminal law against PLWH undermines efforts to engage individuals in healthcare and complicates gendered barriers to linkage and retention in care experienced by women living with HIV (WLWH).MethodsWe conducted a comprehensive review of peer-reviewed and non-peer-reviewed evidence published between 1998 and 2015 evaluating the impact of the criminalization of HIV non-disclosure on healthcare engagement of WLWH in Canada across key stages of the cascade of HIV care, specifically: HIV testing and diagnosis, linkage and retention in care, and adherence to antiretroviral therapy. Where available, evidence pertaining specifically to women was examined. Where these data were lacking, evidence relating to all PLWH in Canada or other international jurisdictions were included.Results and discussionEvidence suggests that criminalization of HIV non-disclosure may create barriers to engagement and retention within the cascade of HIV care for PLWH in Canada, discouraging access to HIV testing for some people due to fears of legal implications following a positive diagnosis, and compromising linkage and retention in healthcare through concerns of exposure of confidential medical information. There is a lack of published empirical evidence focused specifically on women, which is a concern given the growing population of WLWH in Canada, among whom marginalized and vulnerable women are overrepresented.ConclusionsThe threat of HIV non-disclosure prosecution combined with a heightened perception of surveillance may alter the environment within which women engage with healthcare services. Fully exploring the extent to which HIV criminalization represents a barrier to the healthcare engagement of WLWH is a public health priority.

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“…This paternalism diminished patient autonomy, because patients who were excluded from opt-out HIV testing could have benefited from it. On the other hand, paternalism could also cause HCPs to omit offering patients the opportunity to decline the test, so a balance between missing testing opportunities while preserving patient autonomy is necessary (Bulman, Mathews, Parsons, & O'Byrne, 2013;Gostin, 2006). Research shows that most patients prefer shared decision-making (Kumar et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Health-care providers’ experiences with opt-out HIV testing: a systematic review

et al. 2015

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HIV is now a manageable chronic disease with a good prognosis, but early detection and referral for treatment are vital. In opt-out HIV testing, patients are informed that they will be tested unless they decline. This qualitative systematic review explored the experiences, attitudes, barriers, and facilitators of opt-out HIV testing from a health-care provider (HCP) perspective. Four articles were included in the synthesis and reported on findings from approximately 70 participants, representing diverse geographical regions and a range of human development status and HIV prevalence. Two synthesized findings emerged: HCP attitudes and systems. The first synthesized finding encompassed HCP decision-making attitudes about who and when to test for HIV. It also included the assumptions the HCPs made about patient consequences. The second synthesized finding related to systems. System-related barriers to opt-out HIV testing included lack of time, resources, and adequate training. System-related facilitators included integration into standard practice, support of the medical setting, and electronic reminders. A common attitude among HCPs was the outdated notion that HIV is a terrible disease that equates to certain death. Some HCPs stated that offering the HIV test implied that the patient had engaged in immoral behaviour, which could lead to stigma or disengagement with health services. This paternalism diminished patient autonomy, because patients who were excluded from opt-out HIV testing could have benefited from it. One study highlighted the positive aspects of opt-out HIV testing, in which participants underscored the professional satisfaction that arose from making an HIV diagnosis, particularly when marginalized patients could be connected to treatment and social services. Recommendations for opt-out HIV testing should be disseminated to HCPs in a broad range of settings. Implementation of system-related factors such as electronic reminders and care coordination procedures should be considered, and a social-justice commitment among HCPs should be encouraged.

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HIV testing in pregnancy: Using women's voices to inform policy

Cited by 3 publications

References 15 publications

Knowledge, attitudes and intended behaviours towards HIV testing and self-protection: a survey of Omani pregnant women

Knowledge, attitudes and intended behaviours towards HIV testing and self-protection: a survey of Omani pregnant women

The impact of criminalization of HIV non‐disclosure on the healthcare engagement of women living with HIV in Canada: a comprehensive review of the evidence

Health-care providers’ experiences with opt-out HIV testing: a systematic review

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