Research Team
- KA Heckert [Department of Public Health & General Practice]
- S Bagshaw [New Zealand Family Planning Association]
- L Fursman [Univ of California at Berkeley]
- M Kipa [Ngai Tahu Development Corporation]
- M Wilson [Department of Public Health & General Practice]
- V Braiden [Department of Public Health & General Practice]
- A Ahuriri-Driscoll [Department of Public Health & General Practice]
Background
It is now possible to significantly reduce the risk of HIV transmission from mother to child, provided the woman's HIV status is known. HIV screening is not part of routine antenatal care in New Zealand. Few antenatal care providers even discuss HIV with their clients. While New Zealand enjoys the lowest HIV infection rates of all OECD countries, seven children have been infected perinatally since 1991. Since 1992, the number of women living with diagnosed HIV infection in the country has nearly tripled.
Methods
Fifty women of reproductive age and different socio-demographic backgrounds were recruited from seven community-based service sites in Christchurch. Each completed an in-depth semi-structured interview to assess; perceptions of personal risk, general HIV knowledge and specific knowledge related to pregnancy and breast feeding, and preferences for HIV screening techniques and provider practices.
Results
Most women, 86%, said they would have the test if it was offered and more than half, 68%, thought knowing one's HIV status would help the baby. Fully 96% of the WASH participants expressed a preference for routine screening during pregnancy, either 'routine compulsory' (13 participants), or 'routine offer and recommended' (31 participants). Knowledge regarding modes of transmission was high, but knowledge of effective treatment during pregnancy and risk attributed to breast feeding and the HIV test was low.
Conclusions
The sample of women who participated in the study was not intended to be representative of women of reproductive age in New Zealand. However, because the results of the WASH study were almost identical to the results found among 22 antenatal women in the 1996 Wellington study and very similar to the results of the randomised control trial of women in Edinburgh reported in 1999, the WASH results may well resound with most New Zealand women.
Study results clearly document that women want to know about the treatment for reducing risk of mother-to-child infection. They want to be offered HIV screening as part of routine standard antenatal care. They want to be informed about all antenatal screening and they want to provide general consent for all antenatal screening. WASH results further indicate that all women, especially antenatal women, should be informed by their primary or maternity care providers about HIV, the treatment available for preventing mother to child infection, and the risks of breast feeding.
Results from both the provider and women's studies in Canterbury suggest that the national guidelines for all antenatal screening deserve to be reviewed. Specifically, the results support the routine offering of HIV screening to all antenatal clients. These results have major implications for changes in policy, practice, and training requirements throughout New Zealand.
Publication
- Heckert K A, Bagshaw S, Fursman L, Kipa M, Wilson M, Braiden V, Ahuriri-Driscoll A. Women's acceptability of screening for HIV in pregnancy. New Zealand Medical Journal 114:509-12, 2001.