Mandatory HIV testing in pregnancy: is there ever a time?

Area of Science:

• Public Health
• Epidemiology
• Women's Health

Background:

• Infants continue to acquire human immunodeficiency virus (HIV) during pregnancy, particularly in high-prevalence southern Africa.
• Emphasis has shifted from voluntary to routine antenatal HIV testing, with proposals for mandatory testing.

Purpose of the Study:

• To evaluate the ethical plausibility and timing of mandatory HIV testing for pregnant women in high-prevalence settings.
• To examine objections to mandatory testing within the context of southern Africa's specific vulnerabilities.

Main Methods:

• Discussion and ethical review of mandatory HIV testing strategies.
• Analysis of socioeconomic and gender-related barriers to HIV prevention and care in southern Africa.

Main Results:

• Mandatory HIV testing is ethically plausible if coupled with guaranteed treatment and care access.
• Significant barriers to testing, treatment, and care access persist for pregnant women in southern Africa.

Conclusions:

• The current moment is not appropriate for implementing mandatory HIV testing during pregnancy in southern Africa.
• Addressing entrenched vulnerabilities and systemic barriers is crucial before mandatory HIV testing can be justified.