Ethical issues in early detection of HIV infection to reduce vertical transmission

Proposals to make prenatal HIV testing routine and universal dramatize ethi cal issues regarding early detection of HIV. These proposals would abolish pretest counseling and written informed consent for prenatal HIV testing. E thical concerns include whether pregnant women are adequately informed that they may refuse such testing and whether patients have an opportunity to o btain more detailed information about the benefits and risks of HIV testing in this context. Several pertinent research questions need to be studied, including whether pregnant women find routine universal HIV testing accepta ble and whether safeguards adequately protect women who receive testing. If analogous policies to enhance early detection of HIV are considered in oth er clinical contexts, the important clinical and ethical differences betwee n vertical transmission and other situations of HIV transmission must be ke pt clearly in mind.