Letter: HIV testing for pregnant women

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The Independent Online
Sir: We welcome the Government's advice that pregnant women in areas of high HIV prevalence should be offered testing ('Bottomley to make HIV testing easier', 17 December), but believe that training is needed to enable health professionals to implement this sensitively.

The main reason for antenatal HIV testing is not in order to encourage infected women to have abortions, although some may choose to do so. This is a delicate decision, since if an HIV-positive woman is ever to bear a child, it is usually better to do so sooner rather than later.

Most babies born to infected women are healthy and uninfected, but the risk of transmission of HIV to the baby is greater if the mother is in a later stage of infection, as is the risk of the mother dying while the child is still young. Thus, to have an abortion means not only the loss of one pregnancy but also the loss of the woman's best-ever chance of becoming a mother.

Nor is antenatal HIV testing justified to prevent transmission through sexual behaviour. There is, unfortunately, no conclusive evidence that HIV testing has preventive benefits, either for keeping seronegative people free of infection, or, in the event of a positive test, for interrupting the chain of transmission to others. What is needed for prevention is not widespread testing, but sustained health education to encourage safe sex.

Voluntary HIV testing can, however, enable services to be offered appropriately in the interests of the health of both mother and child. Women who are found to be HIV positive can be given intensive monitoring during and after pregnancy and, if appropriate, treatment which may delay the onset of disease.

During delivery, procedures which might increase the risk of the baby being exposed to the mother's blood can be kept to a minimum. The mother can be advised of up-to-date scientific information on the risk of transmitting HIV through breast-feeding, and of how to bottle-feed safely to avoid this. Lastly, the baby can be looked after by an experienced paediatrician from birth.

Despite these benefits, the diagnosis of HIV positivity can lead to substantial distress and anxiety, as well as the potential for stigma and social rejection. The emotional burden of a positive test result may be particularly acute for a woman tested antenatally, who is confronted with her own mortality just when family and friends expect her to be full of positive anticipation of the joys of motherhood. It is essential that women are not pressurised into testing, but receive skilled counselling to help them to decide whether to

be tested, together with ongoing

support for those who are HIV

positive.

Yours faithfully,

HILARY CURTIS

Executive Director

British Medical Association

Foundation for AIDS

London, WC1

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