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Dr Colin Ball of Kings College Hospital on Radio 5
Dr Colin Ball of Kings College Hospital speaking on Radio 5 Live: Pregnant women must be encouraged to take HIV tests
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Tuesday, 1 December, 1998, 09:40 GMT
Babies unnecessarily dying of Aids

The leaflets will help women decide whether to take an HIV test
Up to 80% of pregnant women with HIV who attend ante-natal clinics in London are ignorant that their babies' lives could be at risk.

Research shows that pregnant women are the least likely group to have had their HIV clinically diagnosed. Many wrongly assume they have been tested.

In London, one in 533 women is HIV positive, compared to one in 6,222 for the rest of England and Wales.

However, in some areas of London, prevalence is as high as one in 170.

The government is planning to reverse this trend by launching two leaflets to address the problem - one for women in London and the other for midwives around the country.

Giving women choices

The government says the problem is not that pregnant women do not want to take HIV tests.

It is that they are not being offered the choice of having one.

The UK has one of the worst mother to baby HIV infection rates in western Europe.

This is because testing is routinely offered to women in many other countries.

This means the mothers-to-be can take precautions which will reduce the likelihood of their babies contracting the disease.

For example, they can take AZT, one of the drugs used to reduce the spread of the virus which causes Aids.

They can also choose not to breastfeed as the virus is carried in the mother's milk.

AZT

Research studies have shown that the number of babies born to HIV positive mothers who themselves become infected falls by two-thirds if the mother takes AZT and does not breastfeed.

However, there is a risk that mothers who are only treated with AZT may develop resistance to treatment after the birth.

Also, many babies lose their infectivity soon after birth.


Taking the drug AZT can reduce transmission of HIV from mother to baby
Only one in seven children born to HIV positive mothers end up carrying the virus themselves.

Another way of reducing the spread of the virus is through opting for a Caesarian section to prevent the baby becoming infected by the mother's blood as it passes down the birth canal.

Midwives are to be offered training in counselling women about taking the HIV test and in referring them for specialist care if they test positive.

The training is likely to begin early next year.

Midwives have been chosen to offer counselling and support because they are seen as trustworthy by women.

Strong recommendations

The emphasis is not on forcing women to have tests, but on giving them information about the risks they may face and strongly recommending the test in areas where there is a high prevalence of HIV.

Women will be given advice on testing face to face and in written form and will be allowed time to think over their decision and consult their partner.

Karlene Davis, general secretary of the Royal College of Midwives which has worked with the government on the leaflets, said: "Three in four pregnant women who have the virus do not know they are infected.

"Many are missing out on the new drug therapies which are prolonging lives. And babies are dying unnecessarily."

She said partnership working would be necessary to ensure the counselling and support offered to women was "seamless" and she called for extra resources for training midwives.

African women

Around 80% of HIV positive pregnant women are thought to be from Africa, where HIV is rife in some areas.

The Department of Health recommends that special attention be given to services aimed at these women.

Yvonne Moores, chief nursing officer, said efforts would be made to translate leaflets into different languages and to ensure that midwives knew of the cultural issues affecting African women, for example, it may be difficult to persuade many against the benefits of breastfeeding.

Speaking on the eve of World Aids Day, 1 December, public health minister Tessa Jowell said: "Having the courage to opt for an HIV test is an important first step in preventing babies being born with HIV.

"If we can increase the numbers of pregnant women opting for an HIV test, we will diagnose more infections in tie to offer the mothers measures that will significantly decrease the risk of HIV passing to their babies - from one in six to one in 100."


Princess Diana promoted the problems of children with Aids
The strategy for targetting mothers-to-be is part of a review of the nature of HIV infection.

Tessa Jowell said the nature of people's need for support and care had changed in the last three to five years.

Other groups which are likely to be targeted include young gay and bisexual men.

The numbers of new cases are rising among this group after years of decline due to big publicity drives.

Dr Jeremy Metters, deputy chief medical officer, said this was because this group were not being targeted so much by health promotion groups and also because the success of combination drug therapy had led many to mistakenly believe that Aids was no longer a serious illness.

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