Babies: Aids: why shouldn't mothers be told the truth?

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Britain is facing a new Aids epidemic - in children. A growing number of babies are being infected because their mothers have never had an HIV test. Jeremy Laurance, Health Editor, looks at the threat - and how it could be stopped.

"Don't die of ignorance" was the slogan once used to alert the nation to the dangers of Aids. Now, the worst infectious condition of modern times is being passed to the next generation - because of ignorance.

Pregnant women who are infected with the virus are being kept in the dark because there is no routine HIV testing in antenatal clinics. More than 250 HIV-positive women gave birth in 1996, the highest number yet recorded. In total, more than 450 babies are known to have been infected, with the oldest survivors now in their mid-teens.

Up to one in three babies born to HIV-infected women become infected themselves, though it may be years before they find out. With a combination of drug treatment and other precautions - avoiding breast-feeding and opting for a Caesarean delivery - mothers can cut their risk of having an infected baby by two-thirds.

Consultants in HIV medicine say too little is being done to protect unborn babies from the disease. A working party of the Royal Colleges of Obstetricians, Paediatricians and Midwives is preparing guidelines on antenatal HIV testing but some doctors fear these will not go far enough. A series of papers on the issue is to appear in the British Medical Journal in the New Year.

Dr Annemiek de Ruiter, consultant genito-urinary physician in charge of women with HIV at St Thomas's Hospital, London, said pregnant women were routinely tested for syphilis but not for HIV, even though syphilis is far less common. Only when their babies were born and then fell ill of Aids-related illnesses did they discover they were infected.

" I get women screaming at me that all this blood was taken while they were pregnant; surely it must have been tested for HIV. But it wasn't. There is a public misconception that if blood is taken it is tested for everything."

Midwives are supposed to offer all pregnant women an HIV test but they often fail to explain why it is important. Dr de Ruiter said: "It is very much left up to the midwife. We believe it should not just be offered, it should be recommended. It is a shocking thing to learn that you are HIV positive and the women will need counselling but there are now very good treatments we can offer to reduce the risk to the baby. That is a clear benefit." Anonymous testing for HIV has been carried out in antenatal clinics for years to assess the extent of spread of the disease. Last year 34 HIV-positive women gave birth at St Thomas's but only 14 knew they were carrying the virus. In some hospitals, the proportion of infected mothers who know they carry the virus is only 2 to 3 per cent.

Dr Diana Gibb, a consultant paediatrician at the Hospital for Sick Children, Great Ormond Street, said fewer than 10 per cent of infected women in London were detected during pregnancy. A study of the cost of testing is expected to show that it is less than the cost of treating the affected children throughout their lives.

"About one in six babies of infected mothers will carry the virus at birth. That rate is doubled if the mothers breast-feed. We now have substantial opportunities to reduce the transmission rate. Something has got to be done."

By giving the mother the Aids drug AZT during pregnancy and avoiding breast-feeding after birth the transmission rate can be cut from 30 per cent to 5-10 per cent. In France and in the main cities in the United States, most women are tested for HIV and transmission rates are much lower than in the UK.