HIV This Week

Chersich MF, Luchters SM, Othigo MJ, Yard E, Mandaliya K, Temmerman M. HIV testing and counselling for women attending child health clinics: an opportunity for entry to prevent mother-to-child transmission and HIV treatment. Int J STD AIDS. 2008 Jan;19(1):42-6.

This study assessed the potential for HIV testing at child health clinics to increase knowledge of HIV status, and entry to infant feeding counselling and HIV treatment. At a provincial hospital in Mombasa, Kenya, HIV testing and counselling were offered to women bringing their child for immunization or acute care services. Most women said HIV testing should be offered in these clinics (472/493, 95.7%), with many citing the benefits of regular testing and entry to prevent mother-to-child transmission. Of 500 women, 416 (83.4%) received test results, 97.6% on the same day. After 50 participants, point-of-care testing replaced laboratory-based rapid testing. Uptake increased 2.6 times with point-of-care testing (95% confidence interval = 1.4-5.1; P = 0.003). Of 124 women who had not accessed HIV testing during pregnancy, 98 tested in the study (79.0%). Measured by uptake and attitudes, HIV testing in child health clinics is acceptable. This could optimize entry into HIV treatment, infant feeding counselling and family planning services.

Editors’ note: One in four women in this study had not accessed HIV testing during pregnancy, limiting their access to antenatal, perinatal, and post-partum HIV prevention services. Offering HIV testing for mother and father at well-baby clinics and paediatric acute care services can identify babies that have been exposed to HIV infection for cotrimoxazole prophylaxis and assist parents with unmet needs for family planning, an important component (prong 2) of prevention of mother-to-child transmission programmes. If current trials of antiretroviral prophylaxis during breastfeeding prove it is effective, there will be yet another benefit of post-partum HIV testing and counselling.

Ersoy N, Akpinar A. Attitudes about prenatal HIV testing in Turkey. Nurs Ethics. 2008 Mar;15(2):222-33.

The aim of this study was to assess the attitudes of Turkish pregnant women and antenatal health care providers towards prenatal HIV testing. A self-administered questionnaire was used. The relationships between the different groups' knowledge and attitudes were analysed by using the chi-squared statistic. A total of 494 pregnant women and 181 care providers participated. Forty-four per cent of the pregnant women thought that prenatal HIV testing should be mandatory, and 84% of the health care providers thought it should be performed routinely or be mandatory. The majority of the pregnant women (74%) and half of the care providers agreed that the test results should be disclosed first to the pregnant woman. The study results also revealed that most of the prenatal care providers would not protect pregnant women's autonomy and privacy, contrary to the pregnant women's own preferences. It is essential to establish national prenatal HIV testing policies in order to prevent unethical practices and ensure satisfaction for pregnant women and health care providers.

Editors’ note: These discrepancies in the attitudes of prenatal care providers and pregnant women are striking and underscore the importance of Turkey moving now to establish a national policy and programming framework for client-initiated and provider-initiated HIV testing. Protecting the autonomy and privacy of pregnant women, preventing discrimination and stigmatisation of those found to be HIV-positive, providing treatment and care, and agreeing on choices for serostatus disclosure are among the key elements of such a framework.