PRENATAL CARE: ACOG Advocates for Universal HIV Testing
HIV testing for all pregnant women, regardless of their apparent risk, should be a routine part of prenatal care, the American College of Obstetricians and Gynecologists said yesterday at its Annual Clinic Meeting. Under the new "universal testing with notification" recommendation, the nation's 40,000 OB/GYNs will be encouraged to give HIV tests to all pregnant women who do not refuse the screening. "Our aim is to make HIV testing as commonplace as urinalysis during the first prenatal office visit," ACOG Committee on Obstetric Practice Chair Dr. Michael Greene said, adding that the test would not be mandatory. ACOG made the announcement at the launch of its campaign, which will use bilingual educational material to help its members inform patients about HIV testing and treatment options. "The rate of new pediatric AIDS cases has plunged a dramatic 43% since we learned that the drug zidovudine, when given during pregnancy and labor, reduces the rate of perinatal transmission of HIV from 25% to 5-8%," Dr. Stanley Zinberg, vice president of ACOG's practices activities division, said. According to ACOG, an estimated 91% of children with AIDS have mothers who have HIV or are at risk for HIV, one-third of whom do not report a risk for the virus. Noting that under the "old 'universal counseling, voluntary testing' standard" doctors focused only on high-risk women, Zinberg said, "[W]e can't afford any mistaken assumptions or stereotypes about who is really at risk for HIV. We need to test all women." The ACOG recommendations follow similar guidelines issued by the Institute of Medicine, which recognized the potential for problems with reconciling the testing recommendations with state legal barriers. In its 1998 report, IOM noted that under the patient notification clause, women could opt out of testing, eliminating the perceived need for certain types of pre-testing counseling required in many states. ACOG also yesterday released a committee opinion recommending that women with HIV viral loads of more than 1,000 copies per milliliter receive counseling on the risks and benefits of an elective cesarean section in reducing vertical transmission of the virus (ACOG release, 5/23).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.