At least four models of HIV testing have been used for pregnant women: mandatory testing, opt-out testing, opt-in testing and voluntary testing. Although some countries have introduced mandatory screening, this approach has been widely condemned for interfering with the autonomy of pregnant women. UNAIDS, the World Health Organization and the U.S. Centers for Disease Control and Prevention support the routine provision of HIV testing to all pregnant women as part of prenatal screening (opt-out screening).49 Under this policy, physicians begin HIV testing as part of the routine prenatal screening panel. unless a woman chooses not to. Voluntary and informed consent must be obtained. Pregnant women should receive oral or written information about the clinical and preventive benefits of screening, the right to refuse, follow-up services (post-test counselling, medical care and psychosocial support) and the importance of notification to the partner in the event of a positive result. Several countries, including Botswana, have adopted the opt-out approach through legislation.50 Our assessment of rights, sexual and reproductive health, and HIV/AIDS identifies opportunities and barriers to prevention and treatment. We support several broad initiatives to promote the role of the law in mitigating the HIV/AIDS pandemic among women and children: a comprehensive assessment of HIV-related laws and policies, the expansion of legally protected access to HIV/AIDS-related health services, and the universal application of human rights and anti-discrimination laws. Laws and policies are structural interventions that can facilitate or hinder effective prevention and care activities against human immunodeficiency virus (HIV). The recognition of reproductive rights related to HIV/AIDS varies considerably between national legislation. The South African constitution, for example, establishes the right of individuals to „make reproductive decisions,” which includes decisions about pregnancy, childbirth, and postnatal care; Family planning; prevention and treatment of the reproductive system and sexually transmitted infections; and abortion.18 Several countries in Asia and elsewhere have implemented national policies, but there are no laws supporting reproductive rights and the integration of HIV, family planning, and reproductive health services.19 However, many countries in Africa, the Middle East, and Latin America continue to severely restrict reproductive rights. Laws restricting access to abortion, contraception and sex education, for example, have a negative impact on women living with HIV.

They may suffer the consequences of illegal and unsafe abortions or face the difficult choice between abstinence and the risk of transmitting HIV to a sexual partner.20 Act No. 3139 of 19 August 1999 on the prevention of diseases caused by AIDS. National AIDS Strategy of 16 June 1994, approved by Decree No. 9/KEP/MENKO/KESRA/VI/1994. Mexican Official Decree No. NOM-010-SSA2-1993 on the Prevention and Control of HIV Infection, as amended up to 16 March 2000. Given the importance of the law to HIV prevention work, CDC has implemented public health law methods to systematically collect and evaluate legal and regulatory frameworks in various jurisdictions to determine whether these legal frameworks act as barriers or facilitators to effective HIV prevention. DHAP focused on the public health impact of state laws and regulations in key areas of HIV prevention, such as HIV testing, Medicaid reimbursement for routine HIV testing, laboratory reporting of CD4 data and viral load for HIV surveillance, and criminalization of potential exposure to HIV. Discrimination in accessing HIV-related health services is a major obstacle to good reproductive health for people living with HIV/AIDS.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has defined discrimination against HIV as „any measure involving an arbitrary distinction between persons on the basis of their confirmed or suspected HIV status or their state of health”. 21 Widespread discrimination against HIV-positive patients in health care through direct denial of care or health insurance has been observed in North America,22 Europe,23 Africa,24 Asia,25 and Latin America and the Caribbean.26 Such discrimination also undermines HIV prevention and treatment efforts.