Consent and antenatal HIV testing: the limits of choice and issues of consent in HIV and AIDS

The mood of nihilism that affected HIV is now changing. The availability of new therapies allows for cautious optimism--especially in relation to mother-to-child transmission of HIV and preventative interventions. This has prompted a widespread policy shift towards HIV testing in pregnancy. In this context, informed consent is an ethical issue which needs to be addressed. This study reports on two sets of data exploring consent policy and practices in UK antenatal clinics. The first is derived from an audit of obstetric clinics in the UK and Eire (n = 288), with a 91% response rate. The second provided the views on consent and testing of a cohort of pregnant women attending four London antenatal clinics (n = 697). It was found that written consent was more likely to be obtained in units with a universal HIV testing offer (p = 0.0005); 77.8% of women believed consent would be requested, but 17.7% believed they could not refuse an HIV test. Their views were contrasted with those held about other antenatal screening tests. The data show that the generally haphazard method of giving information and obtaining consent in antenatal HIV provision is probably counterproductive in terms of test uptake and the ultimate goal of minimizing maternal-fetal HIV transmission.