The National HIV Testing Policy recommends that all pregnant women should be routinely offered HIV testing. This should be performed with pre-test discussion, preferably at the first antenatal visit.[2] The risk of perinatal transmission of HIV can be significantly reduced by a number of established evidence-based antenatal and postnatal interventions and appropriate care throughout the pregnancy. Pregnancy is an opportune time for women to be tested when they present to clinicians; the consultation allows for the detection of previously undiagnosed infections, especially in a low prevalence country like Australia. Testing women in pregnancy is a high priority and ideally should be performed as early as possible during the pregnancy.
Previous policies had suggested that HIV testing in pregnancy be undertaken based on a risk assessment. However, for most women the only identifiable risk may be heterosexual exposure with a very limited number of lifetime sexual partners. Therefore, the standard risk assessment may not be adequate to test and detect all women with HIV infection. Some women may be at ongoing risk of HIV acquisition throughout a pregnancy. Testing of these women should be offered again later in the pregnancy.
Because prevention of mother-to-child transmission of HIV is highly effective if HIV infection is diagnosed antenatally, routine testing with pre-test discussion is now the standard of care for all pregnant women in Australia. In addition, it is important to offer all women with newly diagnosed HIV infection a sexual health screen.
A diagnosis of HIV infection in pregnancy can result in considerable anxiety and often guilt. It will also necessitate testing of the woman’s sexual partners, which may increase the anxiety even further. Some women may be particularly vulnerable because they have fears of rejection or be at risk of physical harm, particularly if they are in a relationship that involves domestic violence. Therefore, special psychosocial support should be offered to all women diagnosed with HIV in pregnancy.