HIV transm'n to child: need for screening
Press release: Monday 13 June
HIV transmission to child highlights urgent need for a national screening programme
The failure of a midwife and hospital to recognise that a pregnant woman was at risk of HIV infection - resulting in a child being infected by its mother as well as the mother not getting early access to medication - highlights the urgent need for a decision on universal antenatal screening for HIV, says the New Zealand AIDS Foundation.
The Foundation’s comment follows publication (today) of a report by the Health and Disability Commissioner into a complaint that an HIV positive woman had received inadequate antenatal care, which meant that her infection went undetected for her (risking deteriorating health and further transmission) and was passed on to the child. Commissioner Ron Paterson found for the complainant and said the case demonstrated an urgent need for a national policy on HIV screening in pregnancy be determined and guidelines (for maternity providers) implemented in a more consistent and effective manner.
“The New Zealand AIDS Foundation endorses these remarks,” says NZAF Executive Director Rachael Le Mesurier. “A child infected with HIV at or around the time of birth is an almost wholly preventable tragedy. If pregnant women are known to have HIV, much can be done to maintain their good health, avoid ongoing transmission and to prevent the child from also being infected. Unfortunately, we currently rely on antenatal providers to ‘selectively screen’ for risk before offering an HIV test, a process which has been demonstrated internationally to be ineffective, especially when the profile of an ‘at risk’ mother is changing, guidelines are unclear and training in their implementation inadequate.
“This case shows that selective screening on an ‘at risk’ profile is not working. It presumes a static profile of ‘at risk’ behaviour and assumes an up-to-date knowledge of the high-risk countries.
“For example, asking a woman if she ‘has ever been a sex worker’ is not effective. Sex workers in New Zealand in general have very good safe sex practices and are less likely to be at risk than, say, a young New Zealand woman who has had unsafe sex when on their OE in Africa, India or China.
“What is more concerning about the case reported on by Ron Paterson is the fact that the there were three areas where signs should have been picked up by a health professional. Yet the woman was not offered an HIV test, nor was HIV suspected when her blood tests came back with abnormal results or when she had abnormal cervical smear results.”
The New Zealand AIDS Foundation notes that in 2003 (and repeated in 2004) a record five children born in New Zealand were infected with HIV at or around the time of birth. When the mother-to-child transmission rate (when there is no medical intervention) is one-in-four, it would suggest that there are up to a further 15 women who gave birth who don’t know they are HIV positive but, this time, their child was not infected. This shows that a universal screening HIV programme for all pregnant women should be implemented with some urgency.
“Countries such as the United Kingdom, Canada and the Netherlands have discarded ‘targeted communities’ screening as inefficient. They have adopted universal screening with informed consent and opt-out policies. This means that women are still in control as to whether they have the test or not, but ensures that all pregnant women are at least offered the chance to screen for HIV. Clearly this is not happening currently here in New Zealand and the mothers, the children and their families are suffering unnecessarily as a result.”