Is Routine HIV Testing for Pregnant Women a Good Idea?
The Canadian Medical Association and the Society of Obstetricians and Gynaecologists of Canada recommends that HIV testing and counselling be offered to all pregnant women, with their informed consent.
The development of antiretroviral drug therapies and the success of the drug AZT in reducing the rate of mother-to-child HIV transmission from 25% to 8% has resulted in calls for increased testing of pregnant women in Canada. AZT is administered to the woman during pregnancy, labour and delivery and to the newborn for the first 6 weeks.
According to Tasha Yovetich, manager of National Programs at the Canadian AIDS Society, HIV testing for pregnant women varies across Canada. Writing in the Canadian Women's Health Network newsletter, Network, she describes three policy categories:
1. Voluntarily Offering Testing to Pregnant Women with Risk Factors. Pregnant women with specific risk factors are selected through a physician's assessment. This is the policy in Prince Edward Island, Saskatchewan and Ontario.
2. Voluntarily Offering Testing to all Pregnant Women. Pregnant women are counselled about the risks of HIV transmission during pregnancy and offered HIV testing. This is the official policy in Manitoba, the North West Territories and the Yukon. In Manitoba, the Advisory Committee on Infectious Diseases has recommended further that the woman's prenatal record indicate that the HIV test being offered and whether it was accepted or refused.
3. Routinely Testing All Pregnant Women (or optout). HIV becomes part of the routine tests performed during a prenatal exam. In theory, the test is still voluntary; however there is concern that placing the HIV test on a form with other tests, such as rubella and Rh factor, may mean the patient's consent is implied rather than specifically obtained. Alberta, BC, Quebec and Newfoundland use this process, and Ontario plans to follow suit. In Quebec and BC the HIV test is not included on the general prenatal lab form, but is on a separate form, to make sure women are asked specifically about the HIV test.
According to Yovetich, "lowering the rate of mother to child transmissions is an important and worthwhile prevention goal," however she adds that "an emphasis on AZT to decrease transmission during pregnancy has led in some cases to HIV-positive women taking only AZT during pregnancy." This is problematic because single drug therapy is recognized as not the best care in the treatment of HIV. The Canadian Association of HIV Researchers conference last May revealed that 20 of the 40 women taking antiretroviral therapy were taking AZT on its own.
According to Janet Madsen, of the Positive Women's Network in Vancouver, HIV testing of pregnant women is a feminist issue because it raises issues of informed consent and social factors as well as medical issues.
"They've had a sense that they are in a monogamous relationship, "says Madsen. "And to receive such a life-altering diagnosis during pregnancy can be extremely traumatic" for women, who experience anger, guilt and the possibility that they and their child may die because of the diagnosis. Madsen says a physician education program is needed to help women deal with the "devastating news" given during what is typically a happy time of their lives. "The bottom line is that women should have the right to choose," which means informed consent and the right to the best treatment available.
According to Amanda Lea, a nurse and member of the BC/Yukon board of directors of Canadian Nurses in AIDS Care, the issue of HIV testing is directly tied to women's reproductive choice. …