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Open Access Research article

HIV testing among pregnant women living with HIV in India: are private healthcare providers routinely violating women’s human rights?

Purnima Madhivanan12*, Karl Krupp23, Vinay Kulkarni4, Sanjeevani Kulkarni4, Neha Vaidya4, Reshma Shaheen2, Sean Philpott5 and Celia Fisher6

Author Affiliations

1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 Street, HLS 390W2, Miami, FL 33199, USA

2 Public Health Research Institute of India, 89/B, 2nd Cross, 2nd Main, Yadavgiri, Mysore 560020, India

3 Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA

4 Prayas, Amrita Clinic, Athawale Corner, Karve Road, Deccan Gymkhana, Pune 411 004, India

5 The Bioethics Program, Union Graduate College, New York, USA

6 Center for Ethics Education, Fordham University, Bronx, New York, USA

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BMC International Health and Human Rights 2014, 14:7  doi:10.1186/1472-698X-14-7

Published: 24 March 2014

Abstract

Background

In India, approximately 49,000 women living with HIV become pregnant and deliver each year. While the government of India has made progress increasing the availability of prevention of mother-to-child transmission of HIV (PMTCT) services, only about one quarter of pregnant women received an HIV test in 2010, and about one-in-five that were found positive for HIV received interventions to prevent vertical transmission of HIV.

Methods

Between February 2012 to March 2013, 14 HIV-positive women who had recently delivered a baby were recruited from HIV positive women support groups, Government of India Integrated Counseling and Testing Centers, and nongovernmental organizations in Mysore and Pune, India. In-depth interviews were conducted to examine their general experiences with antenatal healthcare; specific experiences around HIV counseling and testing; and perceptions about their care and follow-up treatment. Data were analyzed thematically using the human rights framework for HIV testing adopted by the United Nations and India’s National AIDS Control Organization.

Results

While all of the HIV-positive women in the study received HIV and PMTCT services at a government hospital or antiretroviral therapy center, almost all reported attending a private clinic or hospital at some point in their pregnancy. According to the participants, HIV testing often occurred without consent; there was little privacy; breaches of confidentiality were commonplace; and denial of medical treatment occurred routinely. Among women living with HIV in this study, violations of their human rights occurred more commonly in private rather than public healthcare settings.

Conclusions

There is an urgent need for capacity building among private healthcare providers to improve standards of practice with regard to informed consent process, HIV testing, patient confidentiality, treatment, and referral of pregnant women living with HIV.

Keywords:
India; HIV testing; Antenatal care; Confidentiality; Diagnosis; Qualitative research; Perinatal transmission