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Thursday, January 14, 1999 Published at 01:47 GMT

HIV testing for pregnant women is a 'lottery'

Antenatal HIV tests are not routine in the UK

A public health expert says children are dying needlessly because pregnant women are not being routinely screened for HIV.

The BBC's Richard Hannaford on HIV testing
Dr Angus Nicoll, of the Public Health Laboratory Service Communicable Disease Surveillance Centre, lambasted the "lottery" of ante-natal testing in the UK.

Writing in the Journal of Medical Screening, Dr Nicoll said Britain was lagging behind countries like France and the US, where HIV tests are routinely carried out on women who have given their consent.

Dr Nicoll said the failure to test for HIV is costing the lives of around 40 children in London alone each year.

He also warned that a woman with an infected child could successfully sue, if it could be shown that she had not been offered a test.

The chances of a mother who is infected with HIV passing the virus on to her child can be cut to around 1% if precautions are taken.

These include the use of antiretroviral combination drugs such as Zidovudine, the avoidance of breastfeeding and the possibility of opting for a Caesarian section.

Even if the virus is passed on to a child, measures can be taken to minimise the chance that the child will contract other infections, such as a form of pneumonia known as PCP.

The chance of passing the infection on to a child if precautions are not taken is about 14% if a women does not breast feed and about 25% if she does.

Dramatic cuts

[ image: Pregnant women may transmit HIV to their child]
Pregnant women may transmit HIV to their child
Dr Nicoll said that in France and the USA the numbers of new childhood cases of HIV infection and Aids had fallen dramatically.

"The UK is doing considerably worse than equivalent countries," he said.

"Even in London, where two thirds of HIV positive births in the UK occur, and where routine antenatal testing has been recommended as official policy since 1992, less than 30% of HIV positive mothers had their infections diagnosed before birth in 1997."

Dr Nicholl suggests that some obstetricans, midwives and GPs have found it difficult to take on the issues surrounding HIV testing.

Dr Nicoll: HIV testing should be routine
Health professionals were often reluctant to raise the issue with black African women who are currently most affected by the disease. There were also resource implications for an already over-stretched NHS.

"The majority of women, if recommended to take a test as part of their routine care are very happy do to so," he said, although he added that the situation had improved in some areas since he wrote his article.

An expert working party of health professionals was set up last year to try to reduce the numbers of sick children with acute Aids defining illness.

Among the recommendations were:

  • All those providing antenatal care should ensure that pregnant women are offered and recommended an HIV test as part of routine care in London
  • HIV tests should be readily available to women in all parts of the country.

Lisa Power, Assistant Director of Health Promotion for the HIV and Aids charity the Terrence Higgins Trust, said: "We are fully in favour of standardised practice throughout the NHS.

"It is very important that all pregnant women are offered the opportunity of the test, however it is also important that the right support is available for women who test positive."

Ms Power said many women were unaware that medical help was available if they were infected with the HIV virus.

A London implementation group, including African representation, has been established to oversee reform in the capital.

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