Parental consent or refusal to consent to HIV testing in children

Bolton, Keith Duncan
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Parental Consent or Refusal to Consent to HIV Testing in Children The acquired immune deficiency syndrome (AIDS) continues to represent the greatest infectious threat to humans of all time. It is estimated that some 33 million people are currently infected with the causative organism, the human immunodeficiency virus (HIV). More than 2 million of these are children. The AIDS epidemic now has its epicenter in sub-Saharan Africa where 75% of deaths occur. The treatment of AIDS with antiretroviral drugs (ARVs) has changed the outcome from inevitably fatal over months to years, to a chronic but manageable condition. Adherence to treatment is essential for maintaining good health and avoiding the development of resistance. Young children with HIV infection usually obtain the virus from their infected mother at, or about the time of birth or via breast milk. Prevention of mother to child infection (PMTCT) is possible through the use of ARVs and this has resulted in a dramatic decrease in infected children in the developed world. Poor provision and uptake of PMTCT in the developing world means that many children are still being infected. In these environments, over 60% of the children who die are infected. Treating these children with ARVs will usually prevent death and return the child to a good quality of life in the family. It is necessary to test the child for infection before embarking on life-long complex treatment and this is done by testing blood or saliva for the virus or antibodies to the virus. A positive test in the child is usually a proxy for a positive test in the mother and this obviously has profound implications for her life. In all infants suspected of infection, a test is advised. In the Rahima Moosa Mother & Child Hospital about 10-15% of mothers refuse testing for their infants. These children are therefore denied the opportunity for life-saving treatment. This essay discusses the reasons why mothers may refuse HIV testing for their infants and explores the possible ethical choices and responses of healthcare workers to this refusal.
MSc (Med) (Bioethics and Health Law), Faculty of Health Sciences, University of the Witwatersrand
HIV/AIDS testing, children, parental consent, parental refusal