Mandatory prenatal HIV testing and the opt-in vs. opt-out debate: African/Caribbean women in Toronto weigh in
U. Ndlovu1,2, W. Tharao3, S. Read4, M. Yudin5, R. Kaul6, A. Gruslin7, L. Leonard8, L. Samson9, F. Murangira10, N. Massaquoi2, F. McGee11
1The Ontario HIV Treatment Network, Toronto, Canada, 2Women's Health in Women's Hands CHC, Toronto, Canada, 3Women's Health in Women's Hands CHC/African and Black Diaspora Global Network on HIV and AIDS, Toronto, Canada, 4Hospital for Sick Children, Toronto, Canada, 5St. Michael's Hospital, Toronto, Canada, 6University of Toronto, Toronto, Canada, 7Ottawa General Hospital, Ottawa, Canada, 8University of Ottawa, Ottawa, Canada, 9Children's Hospital of Eastern Ontario, Ottawa, Canada, 10Community Member, Ottawa, Canada, 11Ministry of Health & Long-Term Care, AIDS Bureau, Toronto, Canada
Background: Mandatory and opt-in or out prenatal HIV testing policies reduce Mother-to-Child-Transmission and encourage early diagnosis and treatment of pregnant women. Yet they raise controversy regarding balancing public health benefits and reproductive agency. Since African/Caribbean women in Toronto are at risk for HIV during their childbearing years, we explored the opinions of forty-three African/Caribbean women (fourteen of whom discovered their HIV+ve status whilst pregnant) and factors that could have influenced their opinions.
Methods: Interviews were conducted as part of the Optimizing Prenatal HIV Testing in Ontario Study. To participate, African/Caribbean women had to have accessed prenatal care and be unaware of their HIV status before receiving it. Interview transcripts were thematically analyzed. Pearson Chi-Square tests were conducted to determine whether HIV status, cultural heritage, place of birth and perception of consent during the previous prenatal HIV testing experience were related to their opinions.
Results: Age: mean 29.2yrs, range 17-44yrs (SD 6.78). Place of Birth: 88%(n=38) were born outside Canada. Cultural Heritage: 44%(n=19) Caribbean, 56%(n=24) African. Religion: 88%(n=38) Christian, 9%(n=4) Muslim. Education: 54%(n=23) had high school education or less. Annual Household Income: 72%(n=31) had CAD$24,999 or less. Mandatory Prenatal HIV Testing: 88%(n=38) YES, 12%(n=5) NO. Opt-out vs. Opt-in: 39%(n=17) OUT, 39%(n=17) IN, 22%(n=9) Don't know. Perception of consent: 65%(n=26) had no choice. 35%(n=14) had a choice, (n=3 missing data). HIV status (p=0.469, 0.166), Cultural Heritage (p=0.387, 0.585), Perception of Consent (p=0.582, 0.395) and Place of Birth (p=0.479, 0.999) were not significantly related to their mandatory testing or Opt-out policy views.
Conclusion: Findings suggest that African/Caribbean women in Toronto, regardless of their HIV status, place of birth, cultural heritage and perception of consent during their previous prenatal testing encounter, support the adoption of mandatory prenatal HIV testing, though remain divided on whether, if given a choice, women should opt-in or out.
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