Natural Health

HIV Testing during Pregnancy

By: Neomi Heroux
Published: Monday, 17 March 2008
ultrasound of unborn baby

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Necessity or Invasion of Privacy?

The CDC (Center for Disease Control and Prevention) recommends that all pregnant women be tested for HIV in the early stages of pregnancy. According to the CDC, early detection and treating of HIV infection can make a big difference in the health of the baby.

The CDC campaign One Test, Two Lives is focused on ensuring that all pregnant women are tested for HIV. Of the babies born HIV infected in 2000, 40% of the mothers were not known to have AIDS before delivery.

On February 5, 2008 the Vermont Department of Health says it is supporting the CDC guidelines and recommending all pregnant women be screened for HIV as part of standard tests performed by a health care provider, unless the women declines to be tested, known as ‘opt-out’. Previously Vermont health care providers offered women counseling and then asked the women to consent to an HIV antibody test ‘opt-in’.

The increased emphasis on screening is to lessen the possibility of perinatal transmission of HIV, the virus that causes AIDS. Perinatal is transmission from mother to child during pregnancy, labor, delivery or breastfeeding.

According to the CDC perinatal transmission accounts for 91% of all AIDS cases reported among children in the United States – and an estimated 17,000 HIV infections among children since the epidemic began in 1981.

If antiretroviral therapy is initiated and adhered to during pregnancy the perinatal rates are 2% or less. If no preventive treatment is received the figure is 25%.

Many young women access regular health care only when they are pregnant. This presents an opportunity not only to screen for HIV, but to educate and advise about the dangers of the virus. In an increasing number of countries, including the UK and many US states, routine testing is offered on an ‘opt-out basis’. That means the patient will receive an HIV test unless they specifically reject the test. When offered the test, about 85-95% of the women agreed to have one.

At this time, early 2008, no country, locale, or city requires mandatory HIV testing for pregnant women. Singapore is considering legislation to enforce mandatory testing to identify all women at risk of transmitting HIV to their babies. This will help to protect the child, but it also removes the woman’s right to informed consent. Whether or not this becomes law, it will have broad implications for women that do not wish to be informed. It would require that the woman’s partner be informed and could cause repercussions for the woman and her baby.

Two states New York and Connecticut require a mandatory HIV test on every newborn baby if the mother was not tested during pregnancy. This may help to identify babies at risk of HIV, it also raises issues:

• Testing newborn babies discloses the mother’s HIV status.
• It does not conclusively show the baby’s HIV status. All babies born to HIV positive mothers will have HIV antibodies. Even uninfected babies will not lose their antibodies until around 18 months.
• Approximately 75% of babies with HIV antibodies do not actually have the virus.
• All babies with HIV antibodies would be given the drug AZT. This would probably prevent HIV developing but is could cause other problems because of the toxicity of the drug.
• If a mother objects to this she may have her baby removed from her care.

All pregnancies put stress, both mental and physical, on the woman. The HIV infected woman will have more problems to deal with. She should work with her health care provider to have the healthiest pregnancy and delivery possible and provide a good start to raising a healthy child.