According to a document recently published by the US Centers for Disease Control and Prevention,1 the province of Ontario, which uses an opt-in approach to prenatal screening for HIV infection, had an abysmal testing rate of only 54%. Such a low rate is clearly unacceptable. Critics of the opt-out strategy argue that it eliminates a woman's autonomy and that it is unethical to perform such an important test without true informed consent. However, given that antiretroviral therapy in HIV-positive pregnant women can potentially reduce vertical transmission rates from about 25% to less than 2%, as reported by Sharon Walmsley in her recent commentary,2 is there really any argument for continuing to offer testing on an opt-in basis?
Mark H. Yudin Obstetrics, Gynecology, & Reproductive Infectious Diseases St. Michael's Hospital Toronto, Ont.
References
- 1.US Centers for Disease Control and Prevention. HIV testing among pregnant women — United States and Canada, 1998-2001. MMWR Morbid Mortal Wkly Rep 2002;51:1013-6. [PubMed]
- 2.Walmsley S. Opt in or opt out: What is optimal for prenatal screening for HIV infection? [editorial]. CMAJ 2003;168(6):707-8. [PMC free article] [PubMed]