Doctoral Students

Shyamala Nataraj PhD completed Feb 2012

Thesis topic: HIV testing of pregnant women in Tamil Nadu, India

Testing pregnant women for HIV in order to prevent transmission from infected women to infants is increasingly advocated as a routine part of antenatal care, and the HIV test is viewed on par with other antenatal tests. Requirements for informed consent to the test have been relaxed to promote testing and treatment to reduce the risk of transmission from infected women to infants and for their own health. Women have the right to refuse the test, and this right is viewed as adequate to protect them from potential stigma and discrimination associated with a positive result.

In this thesis, I draw upon the capabilities approach to examine the extent to which policies by UN agencies and by the Government of India, and the practice of obtaining informed in antenatal care facilities in Tamil Nadu, India, promote women‘s ability to make an informed and voluntary decision about the test. Both qualitative and quantitative methods were used. Results showed that global and Indian policy recommendations for an antenatal test to prevent parent-to-child transmission (PPTCT) target women to the virtual exclusion of male partners, and severely restricted women’s capabilities related to autonomous decision-making about the test.

Furthermore, the PPTCT programme focused almost entirely on testing and treatment and ignored components related to primary prevention for women, and prevention of unintended pregnancies among infected women. A large proportion of pregnant women who tested positive in India, did not receive antiretroviral prophylaxis to reduce the risk of transmission to the infant or antiretroviral treatment for their own heath. In India, infected women who did receive prophylactic treatment received the sub-optimal Nevirapine regimen.

The limitations in policy regarding informed consent were exacerbated in practice. Although test acceptance among women was 100% test, this was not accompanied by their informed consent of women in the overwhelmingly vast majority of cases. In general, both policy makers and healthcare providers dismissed women’s ability to make an informed and voluntary decision about the test, and questioned the feasibility of obtaining an informed consent in Indian settings. In contrast, in interviews with me, women demonstrated their ability to make informed and pragmatic choices by identifying alternate approaches to the test that would help to protect infants from the risk of transmission, while also protecting infected women from potential stigma an discrimination, such as couple counselling and testing, and confidentiality of a positive test result.

(I am currently setting up a project with the South India AIS Action Programme, Chennai, India to help young women develop skills to understand and negotiate with families and communities to help them safeguard their reproductive health and protect against STIs and HIV. I am also working on papers for publication based on the thesis. In the next few months I plan to look for assignments that will help me work on policy and research related to health and livelihood options for young women in resource poor countries.)