title: HIV testing among pregnant women living with HIV in India: are private healthcare providers routinely violating women's human rights?
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.
authors.affiliation: 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. pmadhiva@fiu.edu.
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
authors.forename: Karl
authors.initials: K
authors.lastname: Krupp
authors.forename: Vinay
authors.initials: V
authors.lastname: Kulkarni
authors.forename: Sanjeevani
authors.initials: S
authors.lastname: Kulkarni
authors.forename: Neha
authors.initials: N
authors.lastname: Vaidya
authors.forename: Reshma
authors.initials: R
authors.lastname: Shaheen
authors.forename: Sean
authors.initials: S
authors.lastname: Philpott
authors.forename: Celia
authors.initials: C
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000592:standards; D001291:Attitude of Health Personnel; D057191:Capacity Building; D003219:Confidentiality / Q000592:standards; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006779:Hospitals, Public; D045809:Human Rights Abuses; D006801:Humans; D007194:India / Q000453:epidemiology; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007258:Informed Consent / Q000592:standards; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D011295:Prenatal Care / Q000941:ethics / Q000592:standards*; D017149:Private Sector / Q000941:ethics / Q000592:standards*; D036301:Qualitative Research; D012017:Referral and Consultation; D016079:Refusal to Treat; D055815:Young Adult