Voluntary, named testing for HIV in a community based antenatal clinic: a pilot study

doi:10.1136/bmj.311.7010.928

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I L Chrystie, lecturera,
C D A Wolfe, senior lecturerb,
J Kennedy, midwife counsellorc,
L Zander, senior lecturerd,
A Tilzey, associate specialista,
J E Banatvala, professor of virologya

^aDepartment of Virology, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, St Thomas's Campus, London SE1 7EH
^bDepartment of Public Health Medicine, United Medical and Dental Schools of Guy's and St Thomas's Hospitals
^cDirectorate of Obstetrics and Gynaecology, Guy's and St Thomas's Hospitals, London SE1 7EH
^dDepartment of General Practice, United Medical and Dental Schools of Guy's and St Thomas's Hospitals

Correspondence to: Professor Banatvala.

Accepted 7 July 1995

Despite the increasing advantages of identifying HIV infection in pregnant women, only some 12% of HIV positive women attending antenatal clinics in London have been identified by named testing. As virtually all antenatal care will be community based within the next two to three years, we assessed the problems of introducing named HIV testing during pregnancy into the primary care setting. Planning the service took a considerable time and required the production of educational material for both staff and pregnant women and some reorganisation of procedures. Over a one year period an uptake of 44% was noted. Several problems were encountered including an average of 21 minutes needed to give information on AIDS and HIV, an adverse effect on the midwife-mother relationship, and anxiety (affecting both women and midwives). Possible solutions to this difficult problem are discussed.

The need for a change in screening policy

Anonymous testing for HIV infection among pregnant women has shown that the prevalence of the infection among women attending community antenatal clinics and hospital based antenatal clinics at St Thomas's Hospital rose from 0.05% to 0.44% between 1988 and 19901 and that in London it has risen steadily from 0.18% in 1990 to 0.26% in 1993 (range 0-0.5%).2 3 Such studies have also shown the association of HIV infection in pregnancy with such recognised risk factors as African ethnicity and injected drug use.4 5 Relatively few pregnant women, however, are tested on a named basis, and throughout London only 12% of those found to be positive by anonymised testing were identified by named testing in antenatal clinics.3 6 The Department of Health considers this lack of named testing and identification to be a matter of “considerable public concern.”3

However, some pregnant women do not understand the concept of anonymous testing, think that they have had a named test, …