'Prevention is the best cure' is a common expression, but what happens if preventative measures are not used? A large proportion of pregnant Ugandan women are going out of their way not to be HIV tested, increasing the risk of mother-to-child transmission.
A recent paper by Larsson et al. in AIDS journal discussed how mother-to-child transmission of HIV can be easily and cost-effectively prevented using a short course of antiretroviral therapy. However, this is effective only if the mother is willing to be screened for HIV.
Anne Buve, a member of Faculty of 1000 Medicine, discusses the recent and "worrying" findings of this study, which she describes as "quite sobering". There is currently an opt-out policy for HIV testing even though the HIV prevalence in Uganda is 6.4%.
One year after the implementation of the opt-out policy, fewer than 60% of pregnant women were tested for HIV in 2007 in the majority of countries in Eastern and Southern Africa, the exception being Botswana where voluntary counseling and subsequent testing rates are higher.
Programmes of syphilis screening during pregnancy already faced the same problem in Uganda. However, the authors of the study suggest that women who attended an antenatal clinic that did not have HIV testing on site, did so in order to avoid HIV testing. If confirmed, this finding is worrying.
More studies that identify and tackle the problems that exist with HIV screening need to be carried out, especially in parts of the world that have a high prevalence of HIV. Dr Buve goes on to say, "there should be more studies like this one that look into why people do not have access to or refuse to accept interventions that could prevent HIV infection among their offspring".
More information:
• The full text of the evaluation can be viewed free for 90 days at www.f1000medicine.com/article/28728gjfdm76dyh/id/1165973
• Subscribers can view the original paper, Low uptake of HIV testing during antenatal care: a population-based study from eastern Uganda, by Larsson et al., at journals.lww.com/aidsonline/Citation/2009/09100/Low_uptake_of_HIV_testing_during_antenatal_care__a.21.aspx
Source: Faculty of 1000: Biology and Medicine
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