Find out about the following issues.

Might a woman face 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 appropriate therapy and who is paying for the treatment?

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United Kingdom

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
No. In the UK, nobody can prohibit a woman from becoming pregnant, in whatever circumstances.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
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.

Is the HIV-test part of the maternity care?
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.

Can HIV-infected people legally adopt children?
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.

Is the fact that a woman is HIV-infected a reason for legal abortion?
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.

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
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.

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Denmark

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
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.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
In 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.

Is the HIV-test part of the maternity care?
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.

Can HIV-infected people legally adopt children?
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.

Is the fact that a woman is HIV-infected a reason for legal abortion?
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.

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
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.

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Finland

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
No, a woman cannot be prosecuted for becoming pregnant under any circumstances.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
There are no regulations about this matter.

Is the HIV-test part of the maternity care?
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.

Can HIV-infected people legally adopt children?
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.

Is the fact that a woman is HIV-infected a reason for legal abortion?
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.

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
HIV treatment is free for Finnish citizens.

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France

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
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.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
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.

Is the HIV-test part of the maternity care?
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.

Can HIV-infected people legally adopt children?
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.

Is the fact that a woman is HIV-infected a reason for legal abortion?
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).

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
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).

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Germany

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
No. In Germany nobody can prohibit a woman from becoming pregnant, whatever the circumstances.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
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.

Is the HIV-test part of the maternity care?
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.

Can HIV-infected people legally adopt children?
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.

Is the fact that a woman is HIV-infected a reason for legal abortion?
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.

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
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.

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Italy

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
No, there is no restriction pertaining to it.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
No. In specialized centers for assisted procreation, serum-discordant couples undergo in vitro fertilization treatments (male affected) or artificial insemination (female affected).

Is the HIV-test part of the maternity care?
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).

Can HIV-infected people legally adopt children?
There is no law ruling adoption by seropositives.

Is the fact that a woman is HIV-infected a reason for legal abortion?
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.

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
In Italy, HIV-affected people have free accesso to drugs and exams, which are paid by the National Health Service.

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Portugal

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
No, in Portugal nobody can prohibit a woman from becoming pregnant, in whatever circumstances.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
In Portugal, a doctor who helped an HIV-infected woman to become pregnant is not at risk of legal prosecution.

Is the HIV-test part of the maternity care?
In Portugal the HIV-test is not required by law. However, the test is recommended to pregnant women.

Can HIV-infected people legally adopt children?
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.

Is the fact that a woman is HIV-infected a reason for legal abortion?
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.

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
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.

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Spain

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
No. Under no circumstances can anyone in Spain prohibit a woman from becoming pregnant.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
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.

Is the HIV-test part of the maternity care?
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).

Can HIV-infected people legally adopt children?
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.

Is the fact that a woman is HIV-infected a reason for legal abortion?
If all requirements and reports established by law are met, HIV can be considered grounds for therapeutic abortion.

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
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.

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European Union

Might a woman face legal prosecution if she becomes pregnant despite knowing about her HIV-infection?
There is no applicable EU directive or recommendation. This is considered a matter of national law.

Is a doctor at risk of facing legal prosecution if they help an HIV-infected woman to become pregnant?
There is no applicable EU directive or recommendation. This is considered a matter of national law.

Is the HIV-test part of the maternity care?
There is no applicable EU directive or recommendation. Maternity health care is considered a matter of national law.

Can HIV-infected people legally adopt children?
There is no applicable EU directive or recommendation. The adoption of children is considered a matter of national law.

Is the fact that a woman is HIV-infected a reason for legal abortion?
There is no applicable EU directive or recommendation. Abortion is considered a matter of national law.

Does everybody who is HIV-infected have access to appropriate therapy and who is paying for the treatment?
There is no applicable EU directive or recommendation. Access to health care is considered a matter of national law.

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