November 15, 2002
"Up until now, the approach most areas have taken is 'voluntary opt-in,' where a woman has to specifically say that she wants HIV testing," said Dr. Harold Jaffe of the CDC. "Our report indicates that two other approaches increase testing rates. One is 'voluntary opt-out' in which women are essentially told that HIV testing is the standard here and if you don't want it, we won't do it, but otherwise we will." The other is mandatory testing, adopted by New York and Connecticut. "This approach says that, if you are not tested during pregnancy, we as the state can test your infant with or without your permission," Jaffe said.
Both of these approaches have resulted in a big increase in voluntary prenatal HIV testing rates, Jaffe said. "Unfortunately, right now, most areas have opt-in approaches and the testing rates for that strategy are not very high." The voluntary "opt-out" approach results in prenatal HIV testing rates of 85-98 percent, according to the report, "HIV Testing Among Pregnant Women -- United States and Canada, 1998-2001," published in the CDC's Morbidity and Mortality Weekly Report (2002;51:1013-1016). New York and Connecticut had similarly high rates of 81-93 percent. Voluntary "opt-in," on the other hand, was associated with a wide range of testing rates, from 25 percent to 83 percent. States that switched from an "opt-in" approach to either an "opt-out" or mandatory testing approach increased their prenatal HIV testing rates.
"The data suggest that jurisdictions that use an opt-in approach and that have low prenatal HIV-testing rates should reevaluate their approach," the authors wrote.