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Prevention of Mother to Child Transmission of HIV (PMTCT)
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Page 7
A pregnant woman infected with HIV can transmit the virus to her fetus in the womb, during childbirth, or while breastfeeding. In the absence of intervention, the risk of mother-to-child transmission (MTCT) is 20-45%. MTCT is the most significant source of HIV infection in children below age 10. The risk of transmission can be reduced by over 40 percent by the use of antiretroviral drugs, given peripartum to the mother, or the infant, or both. In light of the clear health benefits, strong measures, sometimes of a compulsory nature, have been proposed (and enacted) for testing of pregnant women and infants, in which the interests of the child may be pitted against those of the mother.
Legal and Policy Considerations
Testing - Although the increased efficacy of antiretroviral drugs in controlling HIV infection and reducing MTCT provides a strong public health justification for widespread testing, most policy makers and health care providers oppose mandatory HIV testing for pregnant women (although many experts support routine prenatal screening). Considerations of patient autonomy are supplemented by concerns that mandatory testing may deter women from future HIV testing, prenatal care, or general medical care. Some jurisdictions do, however, impose mandatory screening on newborns if the mother does not consent to an HIV test. Policy makers and health care professionals are split on the advisability of universal screening-routine counseling and testing for all pregnant women-not just those typically considered at risk. UNAIDS, WHO, and CDC support routine offer of HIV testing to pregnant women (see Topic 1.1).
The majority of pregnant women agree to an HIV test after culturally appropriate counseling. It is important that such counseling make clear that refusal of an HIV test does not jeopardize prenatal care or legal rights. Furthermore, it should assure pregnant women that an HIV-positive result will be kept confidential (health care providers should not disclose a woman's HIV status to her spouse or partner over her objections because of the fear of domestic violence) and that it may not be used against the woman in legal proceedings, for example, to challenge child custody.
Treatment - Health care professionals, courts, and policy makers faced with a pregnant woman refusing PMTCT interventions must determine the legal and ethical balance between the adult...
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Request your trial- Legal Aspects of HIV/AIDS. A Guide for Policy and Law Reform
- Public Health Policies and Practices
- Surveillance, Screening, and Testing for HIV and AIDS
- Prevention of Mother to Child Transmission of HIV (PMTCT)
- Disclosure of HIV Information
- Partner Notification: The Responsibility of the Patient
- Partner Notification: The Duty of the Physician or Counselor
- Partner Notification: The Powers of Government Agencies
- Isolation and Quarantine
- Blood/Tissue/Organ Supply
- Universal Infection Control Precautions
- Postexposure Prophylaxis
- Access to the Technical Means of Prevention (Condoms)
- Male Circumcision
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