Why Don't Health Care Workers Screen All Pregnant Women in My Community for HIV?

Abstract

Maithe Enriquez, PhD, RN, ANP, is assistant professor, School of Nursing, and assistant clinical professor, School of Medicine, University of Missouri, Kansas City, and practices at Truman Medical Center Hospital Hill, Kansas City. I am a nurse practitioner who cares for HIV-infected adults at an urban hospital-based infectious diseases clinic. Last year, I began caring for two mothers who had recently been diagnosed with advanced HIV and AIDS who had multiple serious health problems. These two women did not know each other, but I was struck by the similarity of their stories. Both were young mothers with daughters under the age of 2, both were married, both lived in the same suburban area, both had received prenatal care throughout their entire pregnancies, both had delivered their babies at large tertiary care hospitals, both had limited English proficiency, and both had undergone ‘‘a lot of lab tests’’ while pregnant. Hence, both women were certain they had had an HIV screening test during pregnancy. ‘‘How could I have HIV now?’’ they kept asking. So I requested their prenatal medical records, which showed that, unfortunately, neither woman had been screened for HIV during her pregnancy. Sadly, both of their daughters also tested positive for HIV. For the next few months I kept asking myself, ‘‘How could this have happened?’’ Both of these women became pregnant after the September 2006 Centers for Disease Control and Prevention (CDC) recommendation that HIV testing become universal, routine, and opt-out (CDC, 2006). These women both lived in a state that had no restrictive HIV testing laws in place at the time of the CDC opt-out testing recommendation (Bartlett et al., 2008). Furthermore, The American College of Obstetricians and Gynecologists published a committee opinion in December 2007 stating that opt-out HIV testing ‘‘may identify