Women should be tested at time of abortion

EDITOR—The editorial by Mercey focuses on testing pregnant women attending antenatal clinics as the main means of reducing the vertical transmission of HIV.1 Most pregnant women seeking induced abortions would not have attended antenatal clinics.

In 1996, 167 648 women aged 14 to 49 years had induced abortions. Goldberg et al found that HIV infection often occurs among women thought to be at low risk, and that those having terminations should be included when studying populations of pregnant women in areas of high prevalence.2 Birthistle et al showed that women who were seeking terminations — a high risk population — were not being tested in south west London, an area of high prevalence.3

Several studies have consistently found higher prevalence rates of HIV infection among pregnant women attending for termination than among those attending antenatal clinics. Rey et al4 reported that pregnant women who went on to deliver were more likely to have been tested for HIV during pregnancy than those who underwent elective abortion, yet women choosing abortion were more likely to engage in risky sexual behaviour than those continuing their pregnancy. The findings also suggested that pregnant women choose to be tested for HIV largely out of concern for the fetus.

Young single women constitute the fastest growing group of new cases of HIV infection. It follows that a young woman who tests positive for HIV at the time of requesting an abortion will be more likely to choose not to get pregnant again out of concern about having a baby who might be infected with the virus. However, a young woman having an abortion who is unaware that she is infected with HIV may get pregnant again and decide to continue her pregnancy. By the time she attends an antenatal clinic and is …