ABSTRACT: Because human immunodeficiency virus (HIV) infection
often is detected through prenatal and sexually transmitted
disease testing, an obstetrician–gynecologist may be the first
health professional to provide care for a woman infected with
HIV. Universal testing with patient notification and right of
refusal ("opt-out" testing) is recommended by most national
organizations and federal agencies. Although opt-out and "opt-
in" testing (but not mandatory testing) are both ethically
acceptable, the former approach may identify more women who are
eligible for therapy and may have public health advantages. It
is unethical for an obstetrician–gynecologist to refuse to
accept a patient or to refuse to continue providing health care
for a patient solely because she is, or is thought to be,
seropositive for HIV. Health care professionals who are infected
with HIV should adhere to the fundamental professional
obligation to avoid harm to patients. Physicians who believe
that they have been at significant risk of b