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Uptake of HIV Prophylaxis
- Ciel Heo (29 September 2004)
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Ciel Heo, Medical Student Macarthur Health Service
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[Re:] Painter, T.M. et al, Women’s reasons for not participating in follow up visits before starting short course antiretroviral prophylaxis for prevention of mother to child transmission of HIV: qualitative interview study, British Medical Journal, 329 4 Sep 2004 (electronic) I read with interest the paper by Painter, T.M. et al1, and I believe that the importance of prevention of diseases cannot be more emphasized, although the achievement of modern medicine in terms of treatment and cure is prominent. The study result of this article again reminded us how important the public education is to reduce prevalence of diseases, though there were other factors that contribute the avoidance of follow-up by women with HIV-1 positive test, such as accessibility, cost, tolerability, peer experience, and cultural differences. Preventative strategies against incurable diseases, of which the incidence can be declined by controlling the possible risk factors, have yielded a significantly positive effect to reduce the incidence. AIDS, for example, is believed to be transmitted as a sexually transmitted disease; through needle sharing; and as a perinatal infection. Safe sex, using disposable, clean needle and antenatal prophylaxis therefore, have proven to reduce the risk of infection. According to the study conducted by Duong et al, the risk of vertical transmission of HIV was markedly reduced from 31.6% to 4.2% when antenatal prophylactic antiretroviral therapy was given to the pregnant women carrying HIV.2 More than 1500 children a day acquire HIV-1 infection from their mother in Africa, of which up to 60% children die within two years after birth.2 Therefore, in my opinion, it would be ideal if all HIV carriers undergo proper education about safety issue and antenatal prophylactic antiretroviral therapy to minimize the chance of vertical transmission. Misconception of HIV transmission and acquisition as well as incomplete knowledge of prophylactic treatment, however, seem to be prevalent among new mothers with HIV positive result, not only in Africa but also in other developed countries. That is, only 11% and 56% of women completely understood the prophylactic program in Africa and four states of USA respectively. 1,4 Although this did not appear to affect the rate of prenatal test,4 there is no point to proceed such screening test if the candidates would not initiate or continue the prophylactic therapy. Public health efforts, therefore, should be made to educate the mother-to-be about methods of preventing vertical transmission of HIV by providing them sufficient information; and to explain clear instruction of the therapy. It is one recommended method to provide them a survey questionnaire to ensure their level of understanding. Finally, health care professionals and all staffs working at such institution should respect and consider their patients as much as possible to enhance the patients’ trust in the public health system. It will be helpful to increase patients’ compliance and cost- effectiveness in terms of public health. From: Ciel Heo 4th year medical student, Macarthur Ambulatory Care Service Campbelltown, NSW 2560, Australia Reference: 1. Painter, T.M. et al, Women’s reasons for not participating in follow up visits before starting short course antiretroviral prophylaxis for prevention of mother to child transmission of HIV: qualitative interview study, British Medical Journal, 329 4 Sep 2004 (electronic) 2. Duong T et al. Vertical transmission rates for HIV in the British Isles: estimates based on surveillance data. British Medical Journal 319:1227-1229, 1999. 3. Dabis, F. and Ekpini, E.R., HIV-1/AIDS and maternal and child health in Africa, Lancet, 259 (9323), 15 June 2002: pp 2097-2104 4. Walter, E.B. et al, New mothers’ knowledge and attitudes about perinatal human immunodeficiency virus infection, Obstetrics & Gynecology, 97 (1), Jan 2001: pp 70-76 Competing interests: None declared |
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