Research Article| Volume 26, ISSUE 1, e37-e40, March 2013

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

Published:October 12, 2012DOI:



      In Canadian provinces with opt-out policies for maternal HIV screening, pregnant women are told HIV screening is routine and are provided with the opportunity to refuse. In Newfoundland and Labrador an opt-out screening policy has been in place since 1997.


      This research study aimed to (1) obtain an increased understanding of the information women receive about HIV/AIDS during the opt-out screening process and (2) to advance the policy related dialogue around best practices in HIV screening within the province of Newfoundland and Labrador.


      Twelve women who were between 14 and 35 weeks gestation participated. Interviews were transcribed verbatim and a thematic analysis was carried out.


      The major themes are that women have difficulty obtaining clear information about maternal HIV screening, are often not told they have the right to refuse maternal screening, and experience paternalism from physicians.


      We recommend that physicians and other health care providers in be reminded that that current opt-out testing requires women's consent and that women must be given the option to refuse the test.


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        • Walmsley S.
        Opt in or opt out: what is optimal for prenatal screening for HIV infection?.
        Canadian Medical Association Journal. 2003; 168: 707-708
        • Mossman C.
        • Ratman S.
        Opt-out prenatal HIV testing in Newfoundland and Labrador.
        JAMC. 2002; 167: 630
        • O’Campo P.
        • Kaczorowski J.
        HIV testing.
        What mothers say: the Canadian Maternal Experience Survey. 2009 (Available at:)
        • Guenter D.
        • Barbara A.
        • Shaul R.
        • Yudin M.
        • Remis R.
        • King S.
        Prenatal HIV testing: women's experiences of informed consent in Toronto, Ontario.
        Journal of Obstetrics and Gynaecology Canada. 2008; 20: 17-22
        • Keenan-Lindsay L.
        • Yudin M.
        HIV screening in pregnancy.
        Journal of Obstetrics and Gynaecology Canada. 2006; 185: 1103-1107
        • Canadian Medical and Association
        Prenatal HIV screening test-resolution GC02-47.
        2002 (Available at:)
        • Peckman C.
        • Newell M.
        Controversy in mandatory HIV screening of pregnant women.
        Current Opinion in Infectious Diseases. 1997; 10: 18-21
        • Armstrong R.
        Mandatory testing in pregnancy: is there ever a time?.
        Developing World Bioethics. 2008; 8: 1-10
        • Canadian Peadiatric Society
        Position statement: testing for HIV infection in pregnancy.
        Paediatrics & Child Health. 2008; 13: 221-224
        • United Nations
        The Universal Declaration of Human Rights.
        1948 (Available at:)
      1. The Constitution Act. Being schedule B to the Canada Act 1982 (UK); 1982, c 11, at s. 7.

        • Canadian HIV/AIDS Legal Network
        HIV testing and pregnancy: medical and legal parameters of the policy debate.
        Canadian HIV/AIDS Legal Network, ON1999
        • Ratman S.
        • Hogan K.
        • Hankins C.
        Prevalence of HIV infection among pregnant women in Newfoundland.
        Canadian Medical Association Journal. 1996; 154: 1027-1032
        • Public Health Agency of Canada
        Perinatal transmission of HIV. HIV/AIDS Epi-updates.
        Public Health Agency of Canada, Ottawa2007
      2. Public Health Agency of Canada. Surveillance report to December 31, 2009. Available at:

        • Maman S.
        • Groves A.
        • King E.
        • Pierce M.
        • Wyckoff S.
        HIV testing during pregnancy: a literature and policy review.
        2008 (Available at:)
        • Bayer R.
        • Edington C.
        HIV testing, human rights, and global AIDS policy: exceptionalism and its discontents.
        Journal of Public Health, Policy, and Law. 2009; 34: 301-323
        • Centre for Reproductive and Rights
        Pregnant women living with HIV/AIDS: protecting human rights in programs to prevent mother-to-child transmission of HIV.
        2005 (Available at:)
        • De Bruyn M.
        • Paxton S.
        HIV testing of pregnant women-what is needed to protect positive women's needs and rights?.
        Sexual Health. 2005; 2: 143-151
        • Canadian AIDS Society
        HIV testing of pregnant women.
        1998 (Available at:)
        • Canadian HIV/AIDS Legal Network
        Vectors, vessels, and victims: HIV and women's human rights in Canada.
        Canadian HIV/AIDS Legal Network, Toronto, ON2005
        • Sandelowski M.
        Whatever happened to qualitative description?.
        Research in Nursing and Health. 2000; 23: 334-340
      3. Newfoundland and Labrador Provincial Perinatal Program. Available at:

      4. Medical Research Council of Canada. Natural Sciences and Engineering Council of Canada & Social Sciences and Humanities Council of Canada. Tri-council policy statement: Ethical conduct for research involving humans. Available at:

        • Canadian HIV/AIDS Legal Network
        Prevention and protection: enhancing both HIV testing and human rights in Canada.
        Canadian HIV/AIDS Legal Network, Toronto, ON2007
        • Mead N.
        • Bower P.
        Patient-centeredness: a conceptual framework and review of the empirical framework.
        Social Science and Medicine. 2000; 51: 1087-1110
        • Ahmed A.
        HIV and women: Incongruent policies, criminal consequences.
        Yale Journal of International Affairs. 2011; Winter: 32-42
        • Charles C.
        • Whelan T.
        • Gafni A.
        What do we mean by partnerships in making decisions about treatment?.
        British Medical Journal. 1999; 319: 780-782