What Works for Women and Girls

9C-1. Safe Motherhood and Prevention of Vertical Transmission:Testing and CounselingIn 2007, only an estimated 18% of pregnant women wereoffered HIV tests (ITPC, 2009). “The purpose of antenatalVCT should be to help a woman prepare for a possible positiveHIV diagnosis, to provide her with information aboutPMTCT options and to enable her to make informed decisionsabout continuing or ending a pregnancy if safe, legalabortion is available” (de Bruyn and Paxton, 2005: 145). Indeveloping country settings, between eight and ten percentof women report having received PMTCT interventions(Pai and Klein, 2009).“PMTCT services provide one ofthe few opportunities to identifywomen across the spectrumof HIV disease, includingasymptomatic patients and thosewith advanced disease”(Abrams et al., 2007: S103).HIV Testing for Pregnant Women Must Respect Their RightsUntil recently, testing and counseling had been offered based on opt-in principles that reliedon women to seek counseling and testing. For the past few years, most programs have beenshifting to routine or “opt-out” testing in which clients are routinely tested in various healthcare settings unless they decide not to be tested. [See Chapter 6. HIV Testing and Counselingfor Women] This practice must be carefully evaluated to ensure women’s rights are respected.“The rationale behind the switch to opt-out testing is that stigmatization will be decreased(that is, women do not feel they are singled out for HIV testing if everyone undergoes the test)and higher percentages of women are then tested” (de Bruyn, 2005: 4). Additional rationalesfor opt-out testing are that opt-out testing is less resource intensive to scale-up and thus canbe made available to more women (WHO and UNAIDS, 2007) and also that there is a publichealth argument for testing as many women and men as possible so that appropriate preventionand care services can be provided with regard to status (de Cock et al., 2003). “A disadvantageof opt-out testing is that it may be routinely imposed and women may not realize they canrefuse the test or dare to do so…” (de Bruyn, 2005: 4).Women have often received HIV tests as part of PMTCT programs. While women are oftenfaced with opt-out testing or even mandatory testing during antenatal care, men rarely accesshealth care in situations where they would be subjected to opt-out or mandatory testing. “Theethics of routine testing has a conspicuous gender dimension...women and girls are more likelyto present at formal health care services than are men and hence are more likely to come undera routine testing policy. Women and girls are also the most likely to face stigma, violence andabuse when their HIV-positive status becomes known….” (Rennie and Behets, 2006: 84). [Seealso Chapter 11B. Strengthening the Enabling Environment: Addressing Violence Against Women]In addition, voluntary consent is called into question when the first time women are offeredtesting is during labor and delivery (Center for Reproductive Rights, 2005). Yet numerousresearch studies conducted in Brazil, Mexico, Cameroon, Russia, Rwanda, Nigeria, Uganda,Zambia, Peru and India have demonstrated successful implementation of a rapid HIV testingWHAT WORKS FOR WOMEN AND GIRLS221