Evidence is growing that the transmission of HIV from mother to child can be substantially reduced if doctors know the woman is positive before birth. But current ante-natal testing policy means that scores of women are missing out.
A new study by the Institute of Child Health in London has found that fewer than one-fifth of the HIV-positive pregnant women in three Thames health regions (21 per cent of all births in England and Wales occur in these regions) were identified before delivery. More than 200 women gave birth between January 1992 and December 1993 without them or their doctors knowing they were infected.
Dr Jennifer Evans, a member of the paediatric HIV team at St Mary's Hospital, London, said that an urgent review of ante-natal HIV testing was needed. In areas where HIV prevalence was high, hospitals should be offering named tests as a routine part of ante-natal care. 'If we knew which women were HIV-positive we could optimise the medical management of mother and child during pregnancy and afterwards. Without question it would improve the quality of their lives.'
Richard Smith, a consultant obstetrician and gynaecologist at the Chelsea and Westminster Hospital, is also in favour of named HIV tests being offered to pregnant women. 'I think the balance has shifted because of the information on breast- feeding, on Caesarean sections and on AZT (the Aids drug).'
It is known that breast- feeding may double the risk of a mother infecting her child. More recently, Caesarean sections have been linked with a lower rate of viral transmission than natural birth, and studies in the US suggested this year that AZT in pregnancy could cut transmission of HIV from mother to baby by two-thirds.
An 'opting-in' policy for HIV testing - in which some women are asked if they want a test - is no longer adequate, Mr Smith says. 'We need to move towards an 'opt-out' policy advising women that in a particular unit we test blood for HIV and if they don't want to test they need to tell us.'
Dr Danielle Mercy, a senior lecturer in genito-urinary medicine at University College Hospital, London, agreed that HIV testing should become a routine part of the tests offered and discussed with all pregnant women.
The Department of Health has backed named HIV testing in inner cities, but some experts feel its advice is not robust enough. Many hospitals have ignored it because testing is costly and increases demands on ante-natal clinics. Others fear they may lose patients to other hospitals with devastating financial consequences in the new NHS market.
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