Find out about the
following issues.
Might a woman facing legal prosecution if she
becomes pregnant despite knowing about her HIV-infection?
Is a doctor at risk of facing legal prosecution
if they help an HIV-infected woman to become pregnant?
Is the HIV-test part of the maternity care?
Can HIV-infected people legally adopt children?
Is the fact that a woman is HIV-infected a reason
for legal abortion?
Does everybody who is HIV-infected have access to antiretroviral
therapy and who is paying for the treatment?
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Might
a woman facing legal prosecution if she becomes pregnant despite
knowing about her HIV-infection?
United Kingdom
No. In the UK,
nobody can prohibit a woman from becoming pregnant, in whatever
circumstances.
Denmark
No. In Denmark it is
legal for an HIV-infected woman to become pregnant. Because
of that she can not be prosecuted for becoming pregnant.
Finland
No, a woman cannot be prosecuted for becoming
pregnant under any circumstances.
France
No. In France,
there is no law to forbid any woman from becoming pregnant.
A woman who is aware that she is infected with HIV - or even
dying - still enjoys complete freedom of choice and can decide
to have a child. The risk of a woman passing on her HIV infection
to her child is 2 to 3% in France, 7 or 8 times lower than
it was ten years ago.
Germany
No. In Germany
nobody can prohibit a woman from becoming pregnant, whatever
the circumstances.
Italy
No, there is no restriction pertaining to
it.
Portugal
No, in Portugal
nobody can prohibit a woman from becoming pregnant, in whatever
circumstances.
Spain
No. Under no circumstances
can anyone in Spain prohibit a woman from becoming pregnant.
European Union
There is no applicable
EU directive or recommendation. This is considered a matter
of national law.
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Is
a doctor at risk of facing legal prosecution if they helpan
HIV-infected woman to become pregnant?
United Kingdom
No. In the UK,
a doctor, whether from the public or private sector, can assist
a woman with HIV to become pregnant.
In the case of IVF treatments, couples
with HIV can receive treatment. However, couples where only
the man has HIV are more likely to receive treatment. This
is because sperm can be washed, therefore removing the infection.
Denmark
n Denmark, it is legal
for an HIV-infected woman to have a child. If the woman lives
in a heterosexual partnership it is also legal for a doctor
to help her to become pregnant. In Denmark, doctors are only
allowed to perform artificial insemination on women living
in a heterosexual relationship. That goes for all women, HIV-infected
or not.
If the woman is HIV-infected the doctor has
to examine the woman's health and inform her about any risks
related to the pregnancy. Based on the examination, the doctor
can advise against pregnancy and even refuse to help the woman
become pregnant.
Finland
There are no regulations
about this matter.
France
In France, a doctor
can legally help an HIV-positive woman to have a child, even
using Medically Assisted Procreation (MAP) techniques. Apart
from the treatment of infertility, HIV seropositivity is also
a legal indication for MAP in France since it reduces the
risk of transmitting the virus to a seronegative partner.
If a woman is infected, she can be artificially inseminated
with her husband's sperm. If a man is infected, his sperm
can be cleaned and its viral burden assessed. A spermatozoon
can often be injected directly into the ovum (ICSI).
These practices are regulated by a legal
document (the decree of the 10th May 2001 related to good
clinical and biological practice in Medically Assisted Procreation).
This text defines criteria for the inclusion of couples and
the organisation of medical assistance measures.
Germany
In Germany, a
doctor who helped an HIV-infected woman to become pregnant
is not at risk of legal prosecution, but he or she might be
sued for indemnity if, after an assisted pregnancy (through
artificial insemination or IVF), the child is born with HIV.
Even with all possible medical
precautions, statistically there still is a risk of under
2% that the child of an HIV-infected mother might get infected
during pregnancy, labour or delivery. This is not considered
to be theoretical (like for example, the extremely low risk
of transmission of the virus after washing the sperm of an
HIV-positive man). Therefore a doctor might face a civil law
suit for indemnity if the child is born HIV-positive. Due
to this uncertain legal situation, doctors in Germany don't
take the risk of performing artificial insemination or IVF
on an HIV-positive woman.
Italy
No. In specialized centers for assisted
procreation, serum-discordant couples undergo in vitro fertilization
treatments (male affected) or artificial insemination (female
affected).
Portugal
In Portugal, a
doctor who helped an HIV-infected woman to become pregnant
is not at risk of legal prosecution.
Spain
In principle,
no. Doctors assess the risks at the time and, according to
the particular situation, provide the patient with information
so that she can give her informed consent. However, a doctor
might still be prosecuted for malpractice if a child were
born with HIV.
European Union
There is no applicable
EU directive or recommendation. This is considered a matter
of national law.
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Is
the HIV-test part of the maternity care?
United Kingdom
An HIV test will
soon be routinely offered to all pregnant women. Currently,
the test is routinely offered in all maternity units in the
UK. Performing the test without consent is classed as an offence.
Exciting new treatments are now available which
vastly reduce the risk of HIV transmission from mother to
baby. This has led doctors to press for all pregnant women
to take an HIV test, so that mother to baby transmission can
be prevented.
If data for statistical purposes is required,
random, anonymous HIV sampling can take place on leftover
blood samples. The samples are not traceable to the patient,
and medical staff will not know which patient the sample belongs
to.
Denmark
A pregnant woman is not
required by law to take an HIV-test. An HIV-test is offered
to risk groups. In Denmark the risk groups are Asians, Africans,
lesbians and addicts who take drugs by injection.
Finland
An HIV test is not compulsory and cannot be carried out without
the mother's consent. However, if the mother is HIV infected,
the infection can only be avoided if medication is started
early enough. If an HIV infection is detected, medication
cannot be started against the mother's will.
France
Yes. Since 1993
in France, an HIV test has been recommended during pregnancy,
but is not compulsory (Law 93-121 of the Public Health Code),
unlike testing for toxoplasmosis and rubella which is conducted
systematically. The French system is based on the principle
of free, informed consent and the right to information and
treatment. Doctors must suggest HIV testing to pregnant women
during their first prenatal visit, but women are free to accept
or refuse the test. In fact, most agree to HIV screening.
Some doctors would like the
test to be made compulsory, but they face strong opposition
in France. In March 2002, the Conseil National du Sida (National
AIDS Council) voted unanimously against systematic testing,
but suggested two changes to the existing law. The first recommendation
was that the explicit consent of pregnant women should be
sought to avoid tests being conducted without their knowledge
(common practice according to the CNS). The second was that
two additional tests should be considered (at the end of the
sixth month and during the final prenatal visit) to detect
possible contamination during pregnancy.
Germany
In Germany, the
HIV-test is recommended for pregnant women but is not required
by law. However, under current interpretation of the law the
doctor is legally bound to inform the woman about HIV and
to offer the test. Many experts are asking for a compulsory
test, because medical precautions for the prevention of mother
to child transmission of the virus can only be taken if the
mother and her doctor know about her HIV-infection.
In general, an HIV-test can
only be carried out legally if the patient gives his or her
explicit consent. An HIV-test, which is carried out without
the patient's consent is legally considered as battery.
Italy
No, it is not routinely performed, but it
is recommended in women during their first pre-natal visit.
In women at risk of infection, it is recommended also during
their first quarter of pregnancy (<36th week).
Portugal
In Portugal the
HIV-test is not required by law. However, the test is recommended
to pregnant women.
Spain
In Spain, women
are recommended to take the HIV test, but it is not a compulsory
legal requirement.
The doctor should inform
the patient about the test and offer it, but cannot oblige
the woman to take it. Some have tried to make HIV testing
obligatory in the interest of providing the baby with the
best treatment, but it is only recommended at present. In
Catalonia, the issue is the subject of a specific report by
the Bioethics Commission of Catalonia (www.gencat.es/scs/cbc).
European Union
There is no applicable
EU directive or recommendation. Maternity health care is considered
a matter of national law.
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Can
HIV-infected people legally adopt children?
United Kingdom
According to the
Adoption Standards, potential adopters should not automatically
be rejected on the grounds of age, health or other factors.
It is therefore left to the discretion of adoption officials
to decide whether the applicant qualifies.
However, adopters must undergo extensive
checks for suitability, including medical check-ups, therefore
the overall chance of any person with a long-term disease
being selected as an adopter is very small.
Denmark
The Danish law on adoption
states that the well being of the child must not be reduced
in any way by the physical and mental health condition of
the adoptive parents (Bekendtgørelse om godkendelse
af adoptant, 2000). It is up to the governmental adoption
board to evaluate whether a specific physical or mental state
is acceptable. So far the board has not had any applications
from HIV-infected people, but according to their published
guidance, a person with HIV or AIDS is not very likely to
be approved as an adoptive parent.
Finland
The Adoption Law does not include regulations
about the adoptive parents' health. The general principle
is that an illness should not be an obstacle for adoption,
as long as it does not pose a risk while the child is young.
A medical check is part of a standard adoption process and
the doctor's statement plays a decisive role in determining
the adoptive parents' suitability. When adopting from abroad,
an HIV test is compulsory for the child and many countries
require an HIV test from the parents as well. When adopting
a Finnish child, an HIV test is not part of the standard medical
check-up.
France
In France, adoptions
are authorised on a local level after a series of investigations
conducted by a bureau of around twenty persons. Applicants
must be at least 28 years old and can be single or married.
Along with many other qualifications, they must show that
they are in good physical and mental health. To do this, they
have to choose a general practitioner and a psychiatrist from
a list supplied by the Adoptions Bureau. The GP can suggest
an HIV test, but it is not compulsory. This doctor must then
certify that there are no medical grounds on which to refuse
the adoption of a child.
Germany
The adoption law
in Germany calls for 'qualified'and 'suitable' parents. Therefore
it lies within the scope of discretion of the official board
who handle the adoptions to decide if an applying couple will
qualify. Since the process includes several extensive health
check-ups, it is practically impossible for people with any
chronic disease to adopt children.
Italy
There is no law ruling adoption by seropositives.
Portugal
The law does not
forbid HIV-infected people from adopting children. However,
adoption in Portugal is a long and complex process, requiring
health tests and it is practically impossible for people with
any chronic disease to adopt children.
Spain
It is not a specific
cause for exclusion from adopting children.
In Spain, a complex system
is used to assess the suitability of candidates to adopt children.
It gives maximum guarantees to adoptees, including psychological
and physical tests assessed by different teams.
European Union
There is no applicable
EU directive or recommendation. The adoption of children is
considered a matter of national law.
[Return to list of Issues]
Is
the fact that a woman is HIV-infected a reason for legal abortion?
United Kingdom
In the UK, abortion
is legal. Normally, abortions take place within the 12th to
14th week of pregnancy. However it is legal to have an abortion
until the upper limit of 24 weeks into pregnancy. Abortions
can take place after 24 weeks only where the pregnancy threatens
the mother's life, or in cases of serious foetal abnormalities.
To have an abortion in the UK, a woman
needs the consent of 2 doctors. With a less than 2% risk of
the HIV infection being passed from mother to baby, HIV is
not in itself a reason for abortion.
Denmark
An HIV-infected, pregnant
woman does not take special position in Denmark. She can have
a legal abortion until the 12th week of the pregnancy like
anyone else. Abortion after the 12th week can only be possible
if complications arise - as with any other pregnant woman.
Finland
Abortion is legal on health or economic
grounds for example. An HIV positive woman can have an abortion
until the 24th week of the pregnancy.
France
In France, elective
(voluntary) abortion has been legal since 1974. Any woman
can decide to terminate her pregnancy until the twelfth week.
After that point, abortion must be medically justified and
is only permitted in exceptional circumstances, for instance
when the health of the mother or unborn child is in danger,
or when this child is suffering from an incurable disease
or a serious congenital defect (anencephaly, for example).
Germany
In Germany, abortion
in general is illegal. The law is not enforced within the
first 12 weeks of pregnancy so long as the woman has sought
official counselling. If the woman has HIV, legal abortion
is possible for medical reasons even later in the pregnancy.
Today this has become a rather theoretical situation since
most women who become aware of their HIV-infection when they
are already pregnant learn about this fact within the first
12 weeks of their pregnancy.
Italy
In Italy, abortion is ruled according to
the law May 22nd 1978, number 194. This law allows the voluntary
interruption of pregnancy before the first 90 days if the
pregnancy, delivery or maternity endangers the woman's physical
or psycological health. This is evaluated in relationship
with her health, her financial, social and family conditions,
the circumstances that led to the pregnancy, and probable
anomalies or malformations of the fetus.
There is no explicit reference to HIV infection, but de facto
the law n° 194 allows abortion before 90 days to all women
who request it, by previous mandatory medical exam and consultation
with specialists and social workers.
Portugal
In Portugal, abortion
is only legal in cases where there is a serious risk to the
mother or baby, and pregnancies resulting from rape. If the
woman is HIV-infected, a legal abortion is possible.
Spain
If all requirements
and reports established by law are met, HIV can be considered
grounds for therapeutic abortion.
European Union
There is no applicable
EU directive or recommendation. Abortion is considered a matter
of national law.
[Return to list of Issues]
Does
everybody who is HIV-infected have access to antiretroviral
therapy and who is paying for the treatment?
United Kingdom
Yes, and treatments are supplied free by the National Health
Service. However, levels of treatment can vary around the
country depending on how close you are to a large regional
hospital with a centre of excellence for HIV. Using private
health care or moving to an area with superior HIV facilities
are ways of receiving optimum treatment.
Denmark
In Denmark everybody
who needs medical treatment for HIV does have access to it.
Anybody with a permanent address in Denmark is guaranteed
treatment from the Public Health Insurance. Treatment for
HIV is done by hospitals. Hospitals are also the only places
to give out antiretroviral drugs. Public Health Insurance
pays for the drugs as well as for medical treatment such as
the routine monitoring of the t-cell amount in the patient's
blood. Other residents such as refugees seeking political
asylum also have access to free treatment at public expense.
Finland
HIV treatment is free for Finnish citizens.
France
In France, any
legal resident has the right to medical treatment, including
therapy for an HIV infection, even if they have not paid into
Social Security (the social insurance fund financed by working
people). It is this fund - paid for by the working population
- that finances drugs, medical treatment (e.g. analysis of
viral burden, antibodies and T-lymphocyte level) and hospitalisation.
The treatment of persons with supplementary (mutual) insurance
as well as social security cover is co-funded by social security
and their mutual insurance company. As for the screening test
itself, it is free (and anonymous).
Germany
In Germany, almost everybody who needs treatment
against HIV has access to it. Most people have health insurance
and all different types of insurance companies are required
to pay for the treatment. For those who don't have any health
insurance, social welfare will pay for the drugs as well as
for the necessary medical treatment (like the routine monitoring
of the viral load and the t-cell amount in the patient's blood).
The only people who don't have access to the treatment are
those who are living in Germany illegally.
Italy
In Italy, HIV-affected people have free
accesso to drugs and exams, which are paid by the National
Health Service.
Portugal
Yes. In Portugal,
almost anybody who needs antiretroviral treatment has access
to it. For the majority of people, the treatment is included
in the National Health Care system and the cost is covered
by the state (although health insurance systems are also increasingly
used). The only people who don't have access to the treatment
are those who are living in Portugal illegally.
Spain
In Spain, the
public health system is free and universal, so the public
system pays for treatment. Some doubts have been posed regarding
those who are not Spanish citizens or legally-established
residents, but the criterion of universal coverage and solidarity
in health care is deeply-rooted and the public system bears
the costs of this treatment.
European Union
There is no applicable
EU directive or recommendation. Access to health care is considered
a matter of national law.
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