Antenatal HIV testing—which way forward?

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Abstract
HIV prevalence in childbearing women is increasing rapidly over time. HIV screening in pregnancy may identify infected women but the implementation of HIV screening policy is fraught with difficulties. This study examined HIV screening in a group of 76 pregnant women attending inner London GP antenatal clinics. Women completed standardized questionnaires to examine the psychological impact of HIV testing on pregnant women generally and to ascertain their information levels, personal views about the testing, its management and its implications. Termination decisions were monitored in response to standardized information on vertical transmission probability, varied for positive and negative framing. Results showed a majority of women endorsing a policy of offering HIV tests, with slightly fewer consenting to the test for themselves. Knowledge of HIV and AIDS or beliefs about the benefits and drawbacks of HIV testing in pregnancy were unrelated to test consent. There were significant differences between consenters and non-consenters in the amount of worry, resentment, and reassurance they believed having the test would cause. Information seeking was prevalent, but invariably from non-professional sources. Worry about HIV testing was significantly associated with perceived risk level (r = 0.4, p < 0.01), but reassurance was not (r = 0.2, ns). A significant main effect for frame showed question wording had an effect on likelihood to consider termination irrespective of the type of condition presented. The main effect for disease reveals that women rated themselves as more likely to consider termination when faced with an equivalent risk of having a baby with HIV than of having a baby with spina bifida or hepatitis B, irrespective of the framing of the question. The results are discussed in terms of the mental health and policy implications of antenatal HIV testing.