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Understanding why women decline HIV testing.

Diane Jones1

  • 1Newham Healthcare, NHS Trust.

RCM Midwives : the Official Journal of the Royal College of Midwives
|March 2, 2005
PubMed
Summary

To improve human immunodeficiency virus (HIV) testing uptake in pregnant women, an audit explored reasons for declining the test. Findings suggest reoffering the HIV test at subsequent visits can increase uptake and ensure informed decisions.

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Area of Science:

  • Public Health
  • Maternal Health
  • Infectious Disease Screening

Background:

  • The Department of Health (DH) set a 90% HIV testing uptake target for pregnant women by December 2002 to reduce mother-to-child transmission.
  • Newham Healthcare Trust's HIV testing uptake ranged from 80% to 90%, with an average of 88%, indicating a need to improve adherence to the DH target.
  • Despite high HIV prevalence in pregnant women in Newham (1 in 160), transmission rates are near zero when diagnosed and managed, highlighting the importance of testing.

Purpose of the Study:

  • To audit the Newham Healthcare Trust's maternity services to assess progress towards the DH's 90% HIV testing uptake target.
  • To explore the reasons why 10-20% of pregnant women declined HIV testing during antenatal care.
  • To identify strategies for improving HIV testing uptake among pregnant women.

Main Methods:

  • An audit of antenatal care records was conducted over a seven-month period.
  • Data were collected on HIV testing uptake and reasons for decline from 2138 returned forms.
  • The audit identified 328 (15%) women who declined HIV testing and 10 new positive cases.

Main Results:

  • HIV testing uptake during the audit period ranged from 74% to 90%, falling short of the 90% target.
  • The primary reasons cited for declining HIV testing included cultural and religious beliefs, and perceptions of not being at risk.
  • Ten new HIV-positive pregnant women were identified during the audit period.

Conclusions:

  • Midwives play a crucial role in educating pregnant women about the importance of early HIV diagnosis and its implications.
  • Reoffering the HIV test at subsequent antenatal visits is recommended to allow women more time to consider the information and discuss it with partners.
  • Addressing cultural and personal beliefs is essential to improve informed consent and increase HIV testing uptake in antenatal care.

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