All pregnant women are now offered a test for HIV antibodies as a routine part of antenatal care. You will have a number of tests which are carried out to make sure that you and your baby get the best possible care. An HIV test is one of these. If you do not want this test you must tell your doctor when asked, otherwise it will be carried out along with other routine checks on your health and your baby's health. You have the right to refuse this test, and you also have the right to be fully informed about the pros and cons of taking the test to help you make up your mind about it.

The test is never done without asking you first.

Should I have an HIV test?

Unless you know that you have HIV, you cannot benefit from treatment that can prevent you from passing on HIV to your baby.

Around one in 125 pregnant women in London are likely to be HIV-positive, and before the introduction of effective treatments about 60 babies were born each year with HIV in England and Wales.

However, unless you or partner have lived in sub-Saharan Africa, or you or your partner have injected drugs and shared needles in the past, your chances of HIV infection are very low. Nevertheless, each year a small number of women without any of these risk factors are diagnosed with HIV in the UK.

What happens if the test is positive?

If you are found to be HIV-positive, this means that you could pass HIV on to your baby during pregnancy, during childbirth or by breastfeeding. Obviously an HIV-positive result affects your own health too.

However, very effective treatment now exists which can reduce the risk of passing on HIV to your baby. Without treatment, the chance of passing on HIV is around one in seven, but with the latest treatment, the risk falls to less than one in a hundred.

Babies are very vulnerable to HIV infection. About one quarter of children born with HIV will develop serious AIDS-related illnesses or will die within the first year of life.

Tests to measure the amount of virus in your blood and the health of your immune system (your ability to fight off some serious infections) will be carried out.

Based on the results of these tests you will be offered several different treatment choices by your doctor:

• immediate combination therapy with three drugs to protect your own health and your baby's health

OR

• treatment with one drug (AZT or nevirapine) during pregnancy if your own health doesn't yet require you to take combination therapy, with treatment during childbirth and treatment for your baby to protect your baby's health

AND

• some doctors will suggest that you should have a caesarean section rather than a normal delivery, because this cuts down the risk even further.

You will also be recommended not to breastfeed because HIV could be passed on to your child through breast milk.

If you don't start treatment right away, or you don't learn that you are HIV-positive until late in your pregnancy, your baby can still benefit from treatment because most cases of HIV infection are believed to occur during childbirth. This means you have time to make up your mind about what you want to do - you don't have to make the decision overnight.

After the birth

After your baby is born, the baby will have to receive a number of treatments and tests to make sure that HIV infection doesn't occur. This will mean quite a few extra hospital visits, and medication for your baby lasting six months. After six months it is usually possible to say for sure whether or not a child has been infected. Before this time the child may have some antibodies from its mother, but these disappear as the baby develops its own immune responses.

Telling people about a positive result during pregnancy

An HIV-positive result is likely to be a big shock for you. One implication of the result is that the father of your child may also be HIV-positive, and you will need to decide what to tell him and when. You may be angry because you fear that he has passed on HIV to you.

You may also be scared of what people will think if they find out that you are HIV-positive. For this reason, it is important to discuss with the doctor, counsellor or midwife that gives you an HIV-positive result who should know about it. Your doctor and other people caring for you are not allowed to tell anyone without your permission, but the information will be written down in your medical record at the clinic where you are receiving your care.

What happens if the test is negative?

If you test negative for HIV, this means that no antibodies to HIV are present in your blood. In most cases this will mean that you and your baby are not at risk from HIV.

However, if you caught HIV less than three months ago the antibodies may not have had time to develop. If you believe you were at risk of HIV infection recently you will need to discuss this with an HIV counsellor and decide when is the best time for you to take the test.

Further information

Further information is available in a booklet published by the Terrence Higgins Trust called Baby Matters.

It is available from:

Terrence Higgins Trust

52-54 Grays Inn Road London WC1X 8JU

Tel: 020 7831 0330