Astill N, Miall L, Shillito J, et al. - As no national guideline covers the management of women at high risk of HIV infection who repeatedly decline HIV testing in pregnancy, researchers were prompted to consider maternal rights plus their duty of care to the infant once born on encounter to a case in Leeds. In Leeds, an established HIV and Syphilis in Pregnancy Multidisciplinary Team (MDT) exists. Discussion within the MDT was undertaken regarding the main issues pertaining to a pregnant woman persistently declining HIV testing: identification of pregnant women declining testing; universal testing vs testing by risk stratification of their infants; calculation of vertical transmission risk; definition of unacceptable risk; timing of the decision to request court authority to test the infant; advanced preparation of court authority request papers. It was decided that testing an infant at birth would be justified when there is an HIV transmission risk > 1 in 1000. Court authority would be requested for infant HIV testing at 32–34 weeks of gestation by the MDT, this would allow the preparation of the court papers in advance of delivery. The Trust Guideline Group, Risk Management team, and legal team reviewed, amended and approved the Leeds Obstetrics and Paediatric Guidelines. The article included the outline of these guidelines. Via this link—http://nww.lhp.leedsth.nhs.uk/common/guidelines/detail.aspx?ID=177—the Neonatal guideline is also accessible. These findings suggest that it remains possible to significantly reduce the risk of vertical transmission once the child is born in case a woman at high risk declines HIV testing in pregnancy, however, the window of opportunity is small. Therefore, suggesting the vitality of pathways already in place to address this prior to delivery.