HIV Testing for PMTCT in Tanzania: Time to move from ‘Voluntary’ to ‘Mandatory’?

Kahabi Ganka Isangula, Audrey Holmes, Sharon Brownie

Abstract


Introduction: Every year, many infants are infected with HIV, mostly in sub-Saharan Africa. This is predominantly attributed to mother-to-child or “vertical” transmission during pregnancy, labor and delivery, and breastfeeding. Advances in antiretroviral therapy (ART) and funding have made the prevention of mother-to-child transmission (PMTCT) of HIV more affordable in sub-Saharan Africa. However, despite this advance and its potential in PMTCT, the uptake of HIV testing among pregnant women as an entry point to PMTCT services remains unsatisfactory in many countries.

Methods & Results: In the present paper, authors’ present a viewpoint that supports mandatory HIV testing for pregnant women and argue that a mandatory HIV testing policy should be adopted in Tanzania. The ongoing debate about implementing mandatory HIV testing for all pregnant women is discussed in terms of a parental obligation towards protecting a newborn child. Evidence for mandatory HIV testing in prisons (e.g., for prostitution related crimes and sexual offenses), as well as mandatory pre-marriage testing is considered. The way in which the legal framework in Tanzania could support mandatory testing is discussed.

Conclusion: Authors’ highlight how a national policy of mandatory HIV testing will increase the enrollment of pregnant women into PMTCT services, minimize the risk of HIV transmission to newborn children, improve health outcomes for both parents and children, and contribute to reducing the burden on limited health resources.

 


Keywords


HIV Testing, PMTCT, Voluntary, Mandatory, Tanzania

Full Text:

PDF

References


Bolu, O, Allread ,V, Creek, T, Stringer ,E, (Eds). (2007). Approaches for scaling up human immunodeficiency virus testing and counseling in prevention of mother-to-child human immunodeficiency virus transmission settings in resource-limited countries. American Journal of Obstetric and Gynecology; 197(3 Suppl): S83-9. Review

Schuklenk, U., & Kleinsmidt, A. (2007). Rethinking Mandatory HIV testing during pregnancy in areas with high HIV prevalence rates: Ethical and policy issues. American Journal of Public Health, 97(7); 1179-1183.

Simmons, R.J et al. (1993). Pneumocystis Carinii Pneumonia among US Children with Perinatally Acquired HIV Infection, 270 JAMA 470, 470-73.

MMWR. (2006). 'Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings', 55;1-17.

Nicholson, E (2003). Mandatory HIV Testing Of Pregnant Women: Public Health Policy Considerations And Alternatives, Duke J. of Gender L. & Pol'y 175.

Rennie ,S., Mupenda, B. (2008). Ethics of mandatory premarital HIV testing in Africa: the case of Goma, Democratic Republic of Congo. Dev World Bioeth.8(2):126-37

UNGASS. (2010). ‘UNGASS Reporting for 2010: Tanzania Mainland and Zanzibar’. Retrieved from http://www.unaids.org/en/Regionscountries/Countries/UnitedRepublicofTanzania/

UNAIDS. (2010). 'UNAIDS report on the global AIDS epidemic. Retrieved from http://www.unaids.org/globalreport/Global_report.htm

Harms, G, Schulze, K, Moneta, I et al (2005). Mother-to-child transmission of HIV and its prevention: awareness and knowledge in Uganda and Tanzania. SAHARA J, 2(2): 258-66

MoHSW. (2011). HIV/AIDS/STI Surveillance Report. National AIDS control Program. Report Number 22. p.19

Perez, F, Zvandaziva ,C, Engelsmann ,B, Dabis , F. (2006) Acceptability of routine HIV testing ("opt-out") in antenatal services in two rural districts of Zimbabwe. Journal of Acquired Immune Deficiency Syndrome, 41(4):514-20

MoHSW. (2003). National Health Policy; United Republic of Tanzania, Retrieved on December 20 , 2014 at http://apps.who.int/medicinedocs/documents/s18419en/s18419en.pdf

Armstrong, R. (2008). Mandatory HIV testing in pregnancy: is there ever a time? Developing World Bioethics, 8(1):1-10.

Baltieri, AB, & Boer, DP. (2011). Do HIV-infected incarcerated sexual offenders deserve a little more attention? The Open Forensic Science Journal, 4, 25-29

Perucci, CA, Michelozzi, P, Arcà, M. (1991). Mandatory test for HIV infections in prison population: evaluation of the efficacy of a screening program. Epidemiol Prev. 13(46): 28-36

Amankwaa AA, Amankwaa LC, Ochie, CO (1999). Revisiting the debate of voluntary versus mandatory HIV/AIDS testing in U.S. prisons. J Health Hum Serv Adm.,22(2):220-36

AIDS Policy Law, (1997). Washington adopts measure for testing prison inmates, 12(11): 4-5.

Tanzania HIV and AIDS prevention and Control Act. (2008). Retrieved on August 9, 2014 at http://www.saflii.org/tz/legis/num_act/haapaca2008336.pdf.

Arulogun, OS, Adefioye, OA. (2010). Attitude towards mandatory pre-marital HIV testing among unmarried youths in Ibadan northwest local government area in Nigeria. African Journal of Reproductive Health, 14(1):83-94

Uneke, CJ, Alo, M, Ogbu, O. (2007). Mandatory pre-marital HIV testing in Nigeria: the public health and social implications. AIDS Care, 19(1): 116-21.

D'Amelio, R, Tuerlings, E, Perito, O, et al. (2001). A global review of legislation on HIV/AIDS: the issue of HIV testing. Journal of Acquired Immune Deficiency Syndrome, 28(2):173-9

AIDS Health Promotion Exchange, (1993). Border restrictions and HIV / AIDS: a public health policy disaster, (1): 12-3.

De Cook, KM, Fowler, et al. (2000). Prevention of Mother –to- Child HIV Transmission in resource poor countries: Translating research into policy and practice. JAMA,283:1175-82.

Li, L, Wu, Z, Wu, S, Lee, SJ et al. (2007). Mandatory HIV testing in China: the perception of healthcare providers. International Journal of STD AIDS, 18(7): 476-81.

Isangula, K, G. (2012). Viewpoint: Moral and Ethical Dilemmas During Medical Doctor’s Strike in Tanzania. Negotiation Processes & Communications eJournal Vol. 4, Issue 12. URL: http://dx.doi.org/10.2139/ssrn.2129024.

Mashauri, FM, Siza, JE, Temu et al.(2007). Assessment of quality assurance in HIV testing in health facilities in Lake Victoria zone, Tanzania. Tanzania Health Research Bulletin, 9(2):110-4

O'Grady , B, Schüklenk, U. (2009). Rethinking mandatory HIV testing. Bioethics. ,23(8):ii.




DOI: http://dx.doi.org/10.14738/assrj.22.895

Refbacks



___________________________________________________________________

Advances in Social Sciences Research Journal; ISSN 2055-0286

Copyright Society for Science and Education, United Kingdom