Health: Failure of HIV tests puts babies at risk

Britain's antenatal services are being blamed for needlessly allowing babies to become infected with HIV. Jeremy Laurance, Health Editor, examines claims that the care provided by obstetricians and midwives has been "shameful and negligent".

For the last seven years, the NHS has been counting the number of pregnant women infected with HIV but nothing has been done to ensure more are tested. Despite a 1992 national policy to improve the detection of HIV in pregnancy, there had been no improvement by the end of 1996 when fewer than one in six infected mothers was identified

The failure has condemned dozens of children to a life of chronic illness and an early death. If a pregnant woman knows she is HIV positive she can halve the risk of transmission to her baby by avoiding breast feeding and reduce it by a further two-thirds by taking a course of the anti-Aids drug, AZT.

It has been estimated that the number of infected babies in London could have been reduced from 40 to 13 a year if all HIV-infected women had been identified.

A series of nine papers published in the British Medical Journal shows that Britain's record is worse than other countries such as France, the US and the Netherlands which offer an HIV test routinely to all women.

In Britain, midwives are supposed to offer all pregnant women an HIV test but they often fail to explain why it is important. One paper shows that many women who went to clinics intending to be tested decided against after meeting the "professionals".

Anonymous testing for HIV, using blood taken for other tests from which all identification has been removed, has been carried out in antenatal clinics for years to assess the extent of spread of the disease. It shows that between 1988 and 1996 there were 1,241 births to HIV-positive mothers who did not know they were infected. Of these, only122 were diagnosed while pregnant.

An estimated one in three babies born to infected mothers are themselves infected, unless action is taken to prevent transmission, but the exact number is not known because it can be years before the children are diagnosed.

Pregnant women are routinely tested for syphilis but not for HIV, even though syphilis is far less common. Professor Anne Johnson of the Department of Sexually Transmitted Diseases at University College London Medical School suggests the reason may be "Aids exceptionalism" - the tendency to regard HIV as different from other infections. She says it is urgent the disease is treated more normally.

In an editorial, Diane Mercey, a senior lecturer in the same department, says compulsory HIV testing is illegal and undesirable but voluntary testing should be recommended to all women.

"The indifference of some obstetricians and an unwillingness by many midwives to broach the issue of testing has meant that Britain has fallen behind other countries in providing pregnant women with access to HIV testing. It is shameful and negligent that we have counted the number of babies at risk of infection since 1990 without acting to reduce their risk."