Routine Antenatal HIV Testing - Essay Example

Running Head: HIV Testing Coercive Antenatal Policies Such As Routine Antenatal HIV Testing May Lead Us down A Slippery Slope towards Routine Caesarean Deliveries [Name of the Writer] [Name of the Institution] One of the most demanding challenges that face the field of medicine is the increase in the incidence of HIV all over the world. Current statistics show that HIV is present with the prevalence of three thirty million people in the developing world. (HIV in Pregnancy, 1998) The issue becomes more challenging as the number of children infected each year with HIV is rising steadily, at around 700,000 children per year. (Antenatal HIV screening, 2004) Over 30% of these children get infected during birth, especially in poorly developed areas like Africa and Asia. The irony is that these modes of transfer of infection are preventable, yet little has been done. The prevalence of HIV infection through the birth route in the UK is a cause of concern and signals the need to take active steps in its prevention. The issue is both complex and highly ethical. On the one hand the need for prevention of HIV transmission clearly rectifies the need for antenatal scanning. On the other hand the choice of conduction of the test is in the hands of the patient and not the hospital or healthcare providers. To do so with out the patient's consent would be illegal and undesirable. The psychological and social disadvantages are one of the major concerns for the patients. (Mercey, 1998) Therefore in order to encourage patients, the testing must in these cases ensure protection against "discrimination, stigmatism and violence."(HIV in pregnancy, 1998) The guidelines put forward by the UK government state that by the 31December 2000, all women are to be offered an HIV test as part of their integral care. The guidelines also insist upon increasing antenatal HIV testing to 50% or more. Further, the guidelines state that these percentages must be increased to 90% so that 80% of the women can be identified for HIV during antenatal testing. (DoH,1999) the policy although well made fails to mention issues of HIV related to immigration, asylum, care for children living in the UK with the disease or parents with disease, and support for mothers who are HIV positive.(Kawonza, 2002) There is no doubt that the identification of the disease in a woman beforehand is better than discovering it late. The chances of reducing the baby's risk of getting HIV can be halved through avoiding breast feeding. (Dunn et al, 1992) These chances can be further reduced via the administration of Zidovudine. (Conner et al, 1994) The policy of universal testing has been introduces, so as encourage women in to taking the test. In this way patients living in area of high risk will be more willing to take the test, as oppose to targeting some part of the total population. (Kawonza, 2002) However, despite efforts, Nicoll et al reports antenatal detection rates of only 7%, with no signs of improvement over time.(Nicoll, 1996p 253). This could be due to patient's fear of breach of confidentiality, especially when the patient herself has just recently found our about her HIV status or when she has not informed anyone of her condition. The introduction of cesarean in cases of HIV positive mothers is currently one of the most recommended techniques to reduce the chances of the baby getting infected. This technique has gained much popularity and approval among the health care workers, and is now currently used in conjunction with antiretroviral drug therapy and avoidance of breast feeding. Clayden (2005) in reference to the renewed guidelines set by the UK relating to pregnancy states that the mode of delivery recommended in such cases is elective caesarean at 38 weeks. Although she does emphasizes on the maternal consent in this regard. (Clayden, 2005) Note that the risk of getting HIV is high at 34 weeks of gestation. (European study, 1992) Although the benefits of choosing caesarean as the mode of delivery does have its merits, recent studies indicate that by doing so, the risks of postoperative complications were increased. (Maiques and Cervera, 1999) This is cause of concern as the patients with HIV already have lowered immune defenses, and by subjecting them to infection risks will in turn be counterproductive. Testing only women is another drawback, as it will lead to undetected cases and poor uptake and may be regarded as discriminatory. (Hawken1995) The option of caesarean delivery is usually done along with the use of anti retroviral drugs. Although both of these have shown reduced HIV acquisition incidences in children, no concrete evidence exists to prove that the caesarean independently is responsible for it.(Garcia, 2000) Women with low baseline viral loads have a reduced percentage of viral transmission. Also, although the incidences are low, the chances of the baby acquiring HIV before birth is also present. Caesarean operations are difficult to carry out prior to rupture of the membranes, as the time of delivery may be unpredictable, and can certainly be very risky if the fetal lung is not mature yet. (Garcia, 2000) Even then there is no guarantee that a baby born with C-section will not have HIV. The patients must also be told of the possible complications of C-section. Browne (2005) in her study states that when given an option, many of the patients opted for vaginal delivery and not cesarean. (Browne, 2005) she concludes that "women with viral loads of Read More