Evaluating the right to autonomy argument in the debate on coercive antenatal HIV testing in South Africa

Several authors have recently argued for coercive HIV testing policies of pregnant women in areas of high HIV prevalence such as South Africa which also have poor uptake in their prevention of mother-to-child transmission (PMTCT) programmes. The autonomy argument, which holds that it is within women’s right to exercise their autonomy in opting out of such programmes, is the most cited argument for rejecting such proposals. This paper examines the autonomy argument and arrives at the conclusion that it is problematic, particularly in the context of a public health intervention, in view of the demands of other competing moral interests, and because it is silent on the ethics of the actual implications of the autonomous decision to opt out of HIV testing.