In this area, the focus has been on prevention of mother to child transmission (MTCT) of HIV infection. The World Health Organization (WHO) emphasizes that prevention of MTCT should be seen as one part of the comprehensive care of the HIV positive pregnant woman i.e., a holistic and life span approach.
Key points
The prevention and care of HIV/AIDS and sexually transmitted infections (STIs) should be part of reproductive health programmes at all levels including primary health care.
The management of pregnancy in HIV-positive women should be seen as part of the comprehensive and long-term care of the woman provided to her at settings within easy reach of her home.
Obstetric management will be similar to that for uninfected women (or women of unknown serostatus) in most instances, although invasive diagnostic procedures should be avoided, and iron folate and other vitamin supplementation should be considered. In areas of high prevalence, these procedures should be for all pregnant women.
HIV testing in pregnancy has a number of benefits in terms of prevention and care for mother and child but this must be balanced against the possible risks of stigmatization, discrimination and violence. In order to avoid or minimize negative consequences, testing must be voluntary and confidential and accompanied by quality counselling.
Counselling
For women in antenatal care (ANC) setting, Voluntary Counselling and Testing (VCT) will facilitate access to the following elements of care:
If the result is negative,
Prevention education to remain negative
Standard antenatal and delivery care
Family planning.
If the result is positive,
Counselling in the immediate period following the result and then ongoing sessions
Prevention education
Counselling for decision on continuation of the pregnancy and referral to appropriate services
Antenatal and delivery care taking into account HIV serostatus
Clinical care for HIV related illness
Counselling for various interventions to prevent MTCT
Counselling for infant feeding support
Family planning.
Appropriate care for HIV/AIDS
As mentioned above, the services provided to the pregnant HIV positive woman should be part of her overall, long term care. The woman needs to be reassured that care and support will not cease after the birth of her child. Elements of continued care include:
Treatment and prophylaxis of common HIV related illnesses
Palliative care
Psychosocial support, through health services or AIDS support organzations
Nutritional advice and support.
In relation to WHO?s Making Pregnancy Safer initiative
The key strategy is to integrate HIV/AIDS/STI services into district level maternal and child care.
The establishment of VCT sites, possibly at antenatal care centres, is the starting point of all efforts to reduce the impact of HIV/AIDS and STIs on pregnancy, both in terms of primary prevention of infection and care of the pregnant woman and her child.
Access to safe abortion (where this is legal) and counselling to ensure informed decision making and consent by the woman, should be part of the services.
Health systems need to be strengthened so that interventions to prevent mother to child transmission (MTCT) of HIV infection, including the use of antiretroviral (ARV) drugs, can be safely and effectively implemented.
WHO and UNAIDS
Have developed guidance on VCT in ANC settings, in anticipation of availability of MTCT interventions, which will be printed soon: “Voluntary Counselling and Testing for HIV Infection in Antenatal Settings: Practical considerations for implementation”.