Voluntary counseling and testing emphasizes the need for voluntary, informed consent prior to testing as well as pre- and posttest counseling. Diagnostic testing refers to HIV testing that occurs within a clinical care setting to aid in patient care management. HIV testing is often used as an umbrella term to refer to both testing and counseling services. Concerns over the gap between needs and reality have led to urgent calls for dealing with this important “unfinished business” and expanding testing in developing countries. 2 This means that most people living with HIV get testing and counseling only when they already have advanced clinical disease. 1 Even in more developed countries, about 20% to 30% of seropositive individuals are unaware that they are HIV positive. Recent estimates based on surveys in 12 high-burden countries in sub-Saharan Africa indicate that a median of just 12% of men and 10% of women in the general population have been tested for HIV and received the results. The use of testing globally, however, is very low. To scale up treatment and prevention, rapid increases in both the volume of testing and the ability to counsel those who are tested are needed. The Provider Initiated Opt – Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice.Testing for HIV is the gateway to treatment, care, and prevention. Conclusions The Opt – Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Discussion Most authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society (Beneficence). After screening from 302 identified relevant articles, 21 articles were retained for the critical review. Methods Papers published in English and French Languages between 19 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature. The provider Initiated Opt – Out Prenatal HIV Screening Approach, recommended by the World Health Organization (WHO) lately has been adopted and translated into policy in most Sub – Saharan African countries. Background Prevention of mother to child transmission of HIV remains a key public health priority in most developing countries.
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