The majority of women testing positive for HIV in antenatal screening programmes were previously unaware of their HIV infection and have an HIV-negative partner, according to a study conducted at the North Middlesex University Hospital. In addition, a significant proportion of women don’t disclose their HIV-status to their partner, and when disclosure does happen, this can lead to rejection.
These findings were presented by Dr Chris Wood to the Sixth International Congress on Drug Therapy in HIV Infection, which took place in Glasgow last week. Investigators conducted a retrospective analysis of the records of all pregnancies involving an HIV-positive mother seen at the hospital between March 1999 and July 2002. A total of 59 pregnancies in HIV-positive women were identified, 48 (81%) in women from Africa. The overwhelming majority of women, 43, were unaware that they were infected with HIV until they were tested in the antenatal clinic.
Investigators found that when the women’s partners were tested for HIV, the majority of results came back negative. When the study population was reviewed as a whole, including the 16 women who already knew they had HIV when they attended the antenatal clinic, 64% had an HIV-negative partner. However, 80% of the partners of women who found out they were HIV-positive for the first time due to antenatal testing were HIV-negative.
Sixteen women (all but one testing HIV-positive for the first time in an antenatal setting) in the study did not tell their partner that they had HIV, with 47% saying that they “were unable to disclose”. Relationships between serodiscordant couples frequently failed, with between 14% and 16% of male HIV-negative partners leaving.
In pregnancies which went to full term, all but one woman (who did not receive treatment) had an HIV-negative or indeterminate baby. However, cases studies were presented to the conference which showed how a negative reaction from a partner could jeopardise effective treatment being provided. In addition, investigators highlighted how asylum status and the threat of “dispersal” could threaten continuity of care.
The investigators conclude that “routine antenatal testing for HIV can potentially lead to detrimental psychosocial outcomes for the newly diagnosed HIV-positive women. Our experience…show that these might include depression, domestic violence, break up of relationship and rejection leading to homelessness and destitution…asylum seekers face dispersal away from support networks.”
To help avoid the potential problems highlighted by their study the investigators recommend that antenatal screening programmes should include the following additional elements: simultaneous testing of partners; educational materials designed specifically for men; the provision of intensive support for pregnant women; appropriate safer sex advice for couples: and, that the dispersal of asylum seekers who are pregnant and HIV-positive stops.
Wood C et al. Disclosure, discordance and decisions – the psychosocial impact of antenatal HIV testing. Poster, Sixth International Congress on Drug Therapy in HIV Infection, 2002.