Ethico-Legal Issues Related to Caregiver-Assisted Oral HIV Self-Testing of Children 18 Months–12 Years in South Africa

Abstract

In this study, ethical issues related to pre-and post-test counselling as well as informed consent when caregivers conduct HIV testing in children aged 18 months to 12 years using self-tests in South Africa were explored. Even though the legal requirements related to HIV testing of children in South Africa may be difficult to apply when caregivers use HIV self-tests in children, the study showed that consideration of this HIV testing approach would be in the child’s best interests and that the protection of children's rights in South Africa facilitates both justice and children’s best interests, including application of non-maleficence and beneficence principles. The study recommends the law on HIV testing of children be revised to make pre-test information optional and to consider HIVST as self-care which would make informed consent unnecessary when self-tests are used in children. More guidance is needed to help parents and guardians consider the views of children according to the children’s evolving capacities when they use HIV self-tests in children. Despite the ethical concerns identified in the study, the researcher recommends caregiver-assisted use of HIV self-tests in children to address suboptimal HIV testing and low treatment rates in children living with HIV in South Afric