Canadian Medical Association’s Endorsement of Universal HIV Testing for Pregnant Women Debated
Providing universal HIV testing of pregnant Canadian women is "in the best interests of unborn children" because it would allow more HIV-positive pregnant women to learn of their status and receive antiretroviral treatment to reduce mother-to-child HIV transmission, a Victoria Times Colonist editorial states (Victoria Times Colonist, 8/26). The Canadian Medical Association last week endorsed a resolution that calls for the national and provincial governments to test all pregnant women for HIV, although the statement includes a provision that would allow women to opt out of the testing (Kaiser Daily HIV/AIDS Report, 8/22). The editorial states that Health Canada supports the CMA resolution on the grounds that individual health professionals should not make the choice regarding whether to offer an HIV test to a pregnant patient. The CMA estimates that between 55% and 60% of Canadian doctors offer HIV testing to pregnant patients, and the editorial states that this proportion "simply isn't good enough" when HIV-positive infants are being born around the world "each day." The CMA's provision that would allow women to opt out of testing would ensure that individual patients are allowed to ultimately make the decision regarding whether they want to be tested, the editorial notes. The editorial concludes, "Providing adequate privacy safeguards, education and support are in place for the mother, the move to universal testing is a sound one that would result in lives saved. It should be uniformly implemented as an important part of prenatal care across the country" (Victoria Times Colonist, 8/26).
Women Should Give Specific Consent to HIV Testing
Although all pregnant women should be offered HIV testing "as early in the pregnancy as possible," the CMA's opt-out clause is flawed and should be replaced by an "opt-in" provision, Michael Yoder, chair of the Canadian AIDS Society, states in a press release. Yoder states that "by placing the HIV test on a requisition form with other tests," such as those for rubella and other diseases, patient consent "may be implied rather than specifically obtained." He contends that patients should be given the opportunity to choose HIV testing by giving them "specific, informed consent" to the screening. Women should also receive counseling before and after the HIV test, Yoder writes. He concludes, "Pregnant women must be given both accurate information and clear choices about testing for HIV. It is unlikely that the CMA's resolution will provide either" (CAS release, 8/23).