Opt-out prenatal HIV testing in Newfoundland and Labrador
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* Kathleen Steel O'Connor
* Susan E. MacDonald

Although we thank Christa Mossman and Samuel Ratnam for their response to our commentary,1 we feel that we did not imply that opt-out screening is not being done in Canada. In fact, we used statistics from Alberta as an example of the increased rates of screening that can be achieved if an opt-out approach is taken. 

We have found policy to be a crucial determinant of screening. In the report of our 1997/98 national survey of physicians, we showed that the highest proportion of physicians reporting that they “always or almost always” screened for HIV in pregnancy were those practising in Newfoundland, the only province which then had a policy of routine screening with an opt-out option.2 Indeed, based on the experiences of Newfoundland and Alberta, we believe that routine screening with the option to opt out would achieve the highest rates of screening while preserving the right of the individual to refuse an HIV test.

**Kathleen Steel O'Connor** Kingston, Frontenac and Lennox & Addington Health Unit Kingston, Ont. **Susan E. MacDonald** Family Medicine Centre Kingston, Ont.

## References

1.  1. Steel O'Connor K, MacDonald SE. Aiming for zero: preventing mother-to-child transmission of HIV. CMAJ 2002;166(7):909-10.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjYvNy85MDkiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY3LzYvNjMwLjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. O'Connor KS, MacDonald SE, Hartling L, Seguin RM, Hollands H, Mowat DL, et al. The influence of prevalence and policy on the likelihood that a physician will offer HIV screening in pregnancy. Can J Public Health 2002;93:31-5.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=11925697&link_type=MED&atom=%2Fcmaj%2F167%2F6%2F630.3.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000174508500008&link_type=ISI)