HIV Testing In Pregnancy Research Articles

Incident HIV acquisition among pregnant women in Botswana: findings from the Tsepamo birth outcomes surveillance study.

In Botswana, where almost all pregnant women known to have HIV receive antiretroviral therapy, a large proportion of vertical HIV transmission may occur among women with incident undiagnosed HIV infection during pregnancy. Botswana guidelines recommend repeat HIV testing every 3 months in pregnancy, with at least one test in the third trimester. We evaluated the rate of repeat HIV testing, calculated HIV incidence during pregnancy and estimated missed seroconversions. In the Botswana Tsepamo Study, we abstracted HIV test dates and results from obstetric records of all women who delivered at maternity wards in 18 communities between 7th May 2017 and 20th August 2021. We defined seroconversion as an initial negative/indeterminate HIV test in pregnancy followed by a positive test during pregnancy/at delivery. The incidence rate (IR) of seroconversion was calculated among women with > = 2 known test dates. Missed seroconversions were estimated among women without a test in the third trimester by applying the IR to the time after the last HIV test until delivery. Among 103,529 women delivering in the study period testing negative at the first test and with known conception and HIV test dates, 29,085 (28%) were tested in one trimester of pregnancy, 73,156 (71%) were tested in ≥2 trimesters of pregnancy and 9628 (9%) had a test in all trimesters. A total of 78,162 (75%) women had a third-trimester test. There were 223 seroconversions (2.58/1000 pregnancies, 0.26%) among those with ≥2 known HIV test dates, yielding an IR of 0.69/100 person-years. Among 25,289 women who did not have a test in the third trimester, we estimate approximately 58 seroconversions may have been missed during pregnancy due to a lack of repeat testing. Factors associated with seroconversion during pregnancy included younger age, less education and not being married. More than two-thirds of women had repeat HIV testing in pregnancy and HIV incidence was low. However, an estimated 21% of seroconversions in pregnancy were likely missed due to a lack of re-testing. To reach the goal of zero new paediatric HIV infections, Botswana will need to intensify repeat HIV testing in the third trimester of pregnancy.

Editorial

Editorial

Evaluation of State-Mandated Third Trimester Repeat HIV Testing in a Large Tertiary Care Center.

The Illinois Perinatal HIV Prevention Act was passed to ensure universal HIV testing once during pregnancy and was extended in 2018 to add third trimester repeat HIV screening. The objectives of this analysis were to describe uptake of, and patient factors associated with, third trimester repeat HIV testing at a high-volume birthing center. This is a retrospective cohort study of people who delivered at a single tertiary care hospital in Illinois during 2018. Women who delivered before 27 weeks, had an intrauterine fetal demise, a known diagnosis of HIV, or no HIV test during pregnancy were excluded. Repeat testing was defined as an HIV test at or after 27 weeks' gestation after an earlier negative HIV test during the same pregnancy. The primary outcome was the proportion of people who received repeat testing prior to delivery. Bivariable analyses were performed to identify patient characteristics associated with documentation of repeat HIV testing. Of 12,053 people eligible for inclusion, 3.4% (n = 414) presented without a documented third trimester repeat HIV test. The proportion of people with repeat testing improved from 80 to >99% in the first year. Patient factors were largely not associated with testing performance although multiparous people were more likely to have documented repeat testing. Rapid implementation of third trimester repeat HIV testing was achieved without disparity. Patient factors were largely not associated with testing performance which reinforces the goal of a universal screen to test all people equitably and effectively without bias. · Little is known about adherence to repeat third trimester HIV testing in pregnancy.. · Universal third trimester HIV screening was implemented with high uptake and without disparity.. · Protocolization of repeat HIV testing in pregnancy may reduce bias compared to risk based-screening..

HIV Test in Pregnancy - 100% Not Reached in 2020

In 2019 38 million people were living with HIV worldwide, more than half of them girls and women. Knowledge about maternal HIV status enables HIV transmission prophylaxis, reducing mother-to-child transmission<1%. We aimed to investigate the implementation of the mandatory documentation of counseling and optional HIV testing in the maternity records as recommended in the German maternity guidelines. In the Obstetric Department of the University Hospital Bonn, maternity records were reviewed from June to October 2020, and pregnant women were interviewed regarding the patients' recall of counseling and HIV testing as well as their attitude towards a universal screening strategy using an anonymous questionnaire. Documentation was incomplete in 11% of maternal records: in 8% there was neither documentation of counseling nor of HIV testing, in 3% documentation of counseling only. In 291 questionnaires 47% of pregnant women could not recall counselling. 90% of pregnant women were in favor of universal HIV testing in pregnancy, 9% were undecided, and 1% opposed it. 55% would support change from an "opt-in" to an "opt-out" screening policy in pregnancy. Documentation of counseling and HIV testing was incomplete in 11% of cases, and nearly half of the women could not recall counselling. New strategies from midwives and obstetricians need to be developed to achieve universal HIV testing in pregnant women leading to zero HIV mother-to-child transmissions.

Third-trimester repeat HIV testing: it is time we make it universal

Since the 1990s, perinatal transmission of HIV has decreased substantially, largely as a result of improved detection secondary to routine HIV screening in pregnancy and the use of antiretroviral therapy. However, despite reductions in HIV transmission, elimination of perinatal transmission, defined as an incidence of perinatal HIV infection of <1 per 100,000 live births and a transmission rate of <1%, remains elusive. An estimated 80% of perinatal transmissions occur after 36 weeks' gestation, which highlights the importance of diagnosis and treatment of maternal HIV infection before the highest-risk period for perinatal transmission. With timely identification of seroconversion, intrapartum and neonatal interventions can lower the risk of perinatal transmission from 25% to 10%, substantially reducing perinatal transmission events. The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend that routine HIV testing be performed in all pregnancies, as early in the prenatal course as possible. Third-trimester repeat testing is only recommended for individuals known to be at high risk of acquiring HIV (ie, those who are incarcerated; who reside in jurisdictions with elevated HIV incidence; who are receiving care in facilities that have an HIV incidence in pregnant women > 1 per 1000 per year; or have signs or symptoms of acute HIV). However, among reproductive-age women, heterosexual intercourse is the most common mode of HIV transmission, and the risk of HIV seroconversion is greater during pregnancy than outside of pregnancy. Furthermore, state statutes for HIV testing in pregnancy are largely lacking. In this clinical opinion, we reviewed the evidence in support of universal third-trimester repeat HIV testing in pregnancy using a successful state-mandated testing program in Illinois. In addition, we provided clinical recommendations to further reduce missed perinatal transmission cases by implementing universal third-trimester repeat testing, obtaining hospital buy-in, monitoring testing adherence, bridging communications across multidisciplinary teams, and engaging clinicians in advocacy work.

Managing women who decline HIV testing in pregnancy and their infants? A multidisciplinary team guideline.

The management of women at high risk of HIV infection who repeatedly decline HIV testing in pregnancy is not covered in any national guideline. In Leeds, we had a case which prompted us to consider maternal rights plus our duty of care to the infant once born. Leeds has an established HIV and Syphilis in Pregnancy Multidisciplinary Team (MDT). The main issues pertaining to a pregnant woman persistently declining HIV testing were discussed within the MDT: identification of pregnant women declining testing; universal testing versus testing by risk stratification of their infants; calculation of vertical transmission risk; definition of unacceptable risk; timing of the decision to request court authority to test the infant; advanced preparation of court authority request papers. It was decided that an HIV transmission risk > 1 in 1000 justified testing an infant at birth. The MDT decision to request court authority for infant HIV testing would be made at 32-34weeks of gestation, allowing the court papers to be prepared in advance of delivery. The Leeds Obstetrics and Paediatric Guidelines were reviewed, amended and approved by the Trust Guideline Group, Risk Management team and legal team. These guidelines are outlined within the article. The Neonatal guideline also is accessible via this link: http://nww.lhp.leedsth.nhs.uk/common/guidelines/detail.aspx?ID=177 CONCLUSIONS: If a woman at high risk declines HIV testing in pregnancy, it remains possible to significantly reduce the risk of vertical transmission once the child is born, but the window of opportunity is small. Therefore, it is vital to have pathways already in place to address this prior to delivery.

859: 4th generation HIV testing in pregnancy: How sure is sure?

859: 4th generation HIV testing in pregnancy: How sure is sure?

Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya

ABSTRACTHealth worker experience and community support may be higher in high HIV prevalence regions than low prevalence regions, leading to improved prevention of mother-to-child HIV transmission (PMTCT) programs. We evaluated 6-week and 9-month infant HIV transmission risk (TR) in a high prevalence region and nationally. Population-proportionate-to-size sampling was used to select 141 clinics in Kenya, and mobile teams surveyed mother-infant pairs attending 6-week and 9-month immunizations. HIV DNA testing was performed on HIV-exposed infants. Among 2521 mother-infant pairs surveyed nationally, 2423 (94.7%) reported HIV testing in pregnancy or prior diagnosis, of whom 200 (7.4%) were HIV-infected and 188 infants underwent HIV testing. TR was 8.8% (4.0%–18.3%) in 6-week and 8.9% (3.2%–22.2%) in 9-month cohorts including mothers with HIV diagnosed postpartum, of which 53% of infant infections were due to previously undiagnosed mothers. Of 276 HIV-exposed infants in the Nyanza survey, TR was 1.4% (0.4%–5.3%) at 6-week and 5.1% (2.5%–9.9%) at 9-months. Overall TR was lower in Nyanza, high HIV region, than nationally (3.3% vs. 7.2%, P = 0.02). HIV non-disclosure to male partners and incomplete ARVs were associated with TR in both surveys [aOR = 12.8 (3.0–54.3); aOR = 5.6 (1.2–27.4); aOR = 4.5 (1.0–20.0), aOR = 2.5, (0.8–8.4), respectively]. TR was lower in a high HIV prevalence region which had better ARV completion and partner HIV disclosure, possibly due to programmatic efficiencies or community/peer/partner support. Most 9-month infections were among infants of mothers without prior HIV diagnosis. Strategies to detect incident or undiagnosed maternal infections will be important to achieve PMTCT.

Missed Opportunities for Repeat HIV Testing in Pregnancy: Implications for Elimination of Mother-to-Child Transmission in the United States.

HIV testing is an effective intervention that is used for reducing perinatal HIV transmission. Centers for Disease Control and Prevention recommends a second HIV test during the third trimester of pregnancy for women in settings with an elevated HIV incidence (≥17 cases per 100,000 person-years). We conducted a retrospective cohort study at a single hospital in Baltimore, Maryland, to determine whether a second HIV test was done and to compare HIV retesting with mandated syphilis retesting. Of women who delivered at this hospital, 98.8% received prenatal care. Descriptive, bivariate, and multivariable analyses were performed. Among 1632 women, mean age was 27.6 years (standard deviation: 6.3), 59.6% were black, and 55.5% were single. HIV retesting was done in 28.4% of women, which was significantly less often compared with the state-mandated syphilis retesting (78.7%, p < 0.001). The odds of having an HIV retest were 15 times higher among women who received prenatal care at a teaching clinic [adjusted odds ratio (aOR): 15.58; 95% confidence interval (CI): 11.12-21.81], and they were lower among women with private insurance (aOR: 0.54, 95% CI: 0.34-0.86). The odds of having a syphilis retest were twice as high among women who received prenatal care at a faculty practice (aOR: 2.17; 95% CI: 1.53-3.09), and they were lower among women with private insurance (aOR: 0.61, 95% CI: 0.43-0.88). Emphasizing an "opt-out" HIV retesting approach through state laws may minimize risk perception, and this is one strategy that can be considered in areas of high HIV incidence to reach the goal of eliminating perinatal HIV transmission in the United States.

HIV Testing in Pregnancy [11F

INTRODUCTION: The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion and the Centers for Disease Control (CDC) guidelines regarding HIV testing in pregnancy state that women should be screened for HIV infection as early as possible during each pregnancy and receive a second HIV test during the third trimester. The purpose of this study is to determine if HIV testing in pregnancy is conducted according to proposed guidelines. METHODS: A retrospective review will be performed on all pregnant women who received at least one prenatal care visit and delivered a live-born infant(s) at an urban university medical center in Southern Florida from January 1–December 31, 2014. CPT billing codes for HIV testing during the prenatal and labor and delivery period will be identified. A subsequent record review will be performed to verify if testing was performed according to guidelines and documented. RESULTS: Preliminary data show that of 3200 live-born deliveries in 2014, 2,137 (66.7%) had at least one prenatal visit during pregnancy, and 1221 (38%) had at least one HIV test billed (HIV test- CPT code) during the pregnancy. Final data will report the gestational age at the first prenatal visit, initial HIV screening, subsequent third trimester screening, and screening on admission to labor and delivery, if indicated. CONCLUSION: Preliminary data based upon CPT billing codes for HIV testing demonstrates screening during pregnancy at an urban university medical center is grossly underperformed according to ACOG and CDC guidelines. Clinicians' adherence to HIV screening guidelines during pregnancy is paramount to eliminating perinatal HIV transmission.

Testing HIV positive in pregnancy: A phenomenological study of women׳s experiences

Objectiveglobally women receive HIV testing in pregnancy; however, limited information is available on their experiences of this potentially life-changing event. This study aims to explore women׳s experiences of receiving a positive HIV test result following antenatal screening. Designa qualitative, phenomenological approach. Settingtwo public National Health Service (NHS) hospitals and HIV support organisations. Participantsa purposive sampling strategy was used. Thirteen black African women with a positive HIV result, in England, participated. Methodsdata were collected using in-depth semi-structured interviews. An interpretive phenomenological approach to data analysis was used. Findingsthe emergent phenomenon was transition and transformation of ‘being,’ as women accepted HIV as part of their lives. Paired themes support the phenomenon: shock and disbelief; anger and turmoil; stigma and confidentiality issues; acceptance and resilience. Women had extreme reactions to their positive HIV diagnosis, compounded by the cultural belief that they would die. Initial disbelief of the unexpected result developed into sadness at the loss of their old self. Turmoil was evident, as women considered termination of pregnancy, self-harm and suicide. Women felt isolated from others and relationship breakdowns often occurred. Most reported the pervasiveness of stigma, and how this was managed alongside living with HIV. Coping strategies included keeping HIV ‘secret’ and making their child(ren) the prime focus of life. Growing resilience was apparent with time. Key conclusionsthis study gives midwives unique understanding of the complexities and major implications for women who tested positive for HIV. Women׳s experiences resonated with processes of bereavement, providing useful insight into a transitional and transformational period, during which appropriate support can be targeted. Implicationsmidwives are crucial in improving the experience of women when they test HIV positive and to do this they need to be appropriately trained. Midwives need to acknowledge the social and psychological impact of HIV and pathways should be developed to support early referral for appropriate support.

The evaluation of accuracy of serial rapid HIV test algorithm in the diagnosis of HIV antibodies among pregnant women in south east Nigeria.

BackgroundAccurate HIV testing in pregnancy is critical to the prevention of mother to child transmission of HIV infection and linkages to other preventive strategies.Aims and objectivesThis study determined the sensitivity, specificity negative and positive predictive value of serial rapid testing of HIV among pregnant women in Nnewi, south east Nigeria.MethodologyThis was a comparative descriptive study conducted over a 4-month period. Serial rapid testing algorithm was compared with conventional ELISA testing after obtaining informed consents from the pregnant women. All positive and discordant results were confirmed with western blot HIV test. Participants also completed a questionnaire. Data analysis was done using SPSS version 20.ResultA total of 166 pregnant women participated in this study. The mean age of the participants was 29 ± 4.3 years. The HIV prevalence was highest in the 25–29 years category. This was also the modal age category. Majority of the women were multiparous. The prevalence of HIV infection was 12 %. The sensitivity, specificity, negative and positive predictive value of serial rapid HIV testing was 95, 100, 99.3 and 100 % respectively.ConclusionThe sensitivity of the serial rapid test algorithm was high but still lower than the WHO recommended 99 % and above. The 100 % specificity and positive predictive value makes it a good diagnostic test strategy. There is need for regular review of HIV test kits and policy.

Percentage and determinants of missed HIV testing in pregnancy: a survey of women delivering in the Lazio region, Italy

HIV testing is recommended as part of routine preconception and prenatal care but some cases of vertical transmission still occur because of missed HIV testing in pregnancy. We estimated the percentage of women missing HIV testing before delivery, and we evaluated factors related with it. An anonymous survey was distributed to women giving birth during a two-week period in the maternity units of hospitals in the Lazio region of Italy in 2011. Among the 1568 women who filled out the questionnaire, only 33.6% had an HIV test prior to conception, while 88.2% were tested during pregnancy; main reasons reported for missed testing were: not requested by the gynaecologist (57.0%), performed previously (20.7%), requested by the gynaecologist but not done (13.3%) and structural/organisational barriers (4.4%). The percentage of women who missed the HIV test as part of preconception care or during pregnancy was 9.1% (95% confidence interval, CI: 7.7–10.6). Multivariate analysis showed that those with missed test were younger (p = 0.05), of lower education level (p < 0.01), with a lower HIV-knowledge score (p < 0.01) and with fewer visits during pregnancy (p < 0.01). Around 10% of delivering women were not tested for HIV during pregnancy or as part of preconception care. Absence of a specific request by the gynaecologist was the most frequent reason given. The association of missed HIV testing with poor sociocultural level and limited maternal HIV knowledge emphasise the importance of promoting HIV information among women and prenatal care providers. Strategies to increase routine testing may include the adoption of an opt-out approach. Finally, availability of rapid HIV testing in the delivery room should be encouraged.

Integration of Preventing Mother-To-Child Transmission of HIV and Syphilis Testing and Treatment in Antenatal Care Services in the Northern Cape and Gauteng Provinces, South Africa

South Africa recommends universal syphilis and HIV testing in pregnancy, with prompt antiretroviral therapy or penicillin treatment for women testing positive. We used a multistage, purposeful sampling strategy to retrospectively identify clinical records from a sample (7.3%) of 32,518 women delivering from January 2005 to June 2006 at 6 public clinics in the Northern Cape and Gauteng. Descriptive analyses and logistic regression were used to assess coverage and factors related to testing and treatment of HIV and syphilis. Of 2379 women sampled, 93% accessed antenatal care (ANC) services during pregnancy and 71% before the third pregnancy trimester. Testing during pregnancy or delivery was 74% for HIV and 84% for syphilis; testing at the first ANC visit was 41% and 71%; and infection prevalence at delivery was 14% and 5%, respectively. Of 243 women with reactive HIV tests, 104 (43%) had treatment documented (single-dose nevirapine) before delivery. Of 98 women with reactive syphilis tests, 73% had documented receipt of 1 penicillin injection and 36% had all 3 recommended injections. Multivariable analysis found women tested for syphilis were almost 4 times more likely to have had no HIV test compared with those without syphilis testing (adjusted odds ratios, 3.9; 95% confidence interval, 1.7-5.5). Integration and provision of a package of HIV and syphilis testing at the first ANC visit and decentralizing treatments of both infections to primary care settings could increase the coverage of testing and treatment services, thus enhancing the effectiveness of current programs eliminating mother-to-child transmission of HIV and syphilis.

HIV testing in pregnancy: Using women's voices to inform policy

In Canadian provinces with opt-out policies for maternal HIV screening, pregnant women are told HIV screening is routine and are provided with the opportunity to refuse. In Newfoundland and Labrador an opt-out screening policy has been in place since 1997. This research study aimed to (1) obtain an increased understanding of the information women receive about HIV/AIDS during the opt-out screening process and (2) to advance the policy related dialogue around best practices in HIV screening within the province of Newfoundland and Labrador. Twelve women who were between 14 and 35 weeks gestation participated. Interviews were transcribed verbatim and a thematic analysis was carried out. The major themes are that women have difficulty obtaining clear information about maternal HIV screening, are often not told they have the right to refuse maternal screening, and experience paternalism from physicians. We recommend that physicians and other health care providers in be reminded that that current opt-out testing requires women's consent and that women must be given the option to refuse the test.

P90 Is a 100% antenatal HIV testing possible?

BackgroundAntenatal HIV testing in the UK has been a resounding success and is credited with reducing the rate of mother to child HIV transmission.AimsTo explore the characteristics of women who did not have the HIV test at booking, the reasons for declining and adherence to local policy on re-offering tests later in pregnancy. Between April 2010 and April 2011 a review of maternity case notes was carried out.Results6723 women were booked in early pregnancy in the relevant time period and 33 (0.5%) of these women did not have a documented HIV test. Notes were only available for 32 of these women.31/32 (96.8%) of the women were UK born, 27 (84.4%) partners were UK born. 11 (34.4%) women were pregnant for the first time. 13 (40.6%) women had no documentation of a HIV test within a year of booking. There was no documentation of intravenous drug use in any of the women or their partners. 7 (21.9%) women did not have any other blood borne virus testing done and none of these women had a recent documented HIV test either. Only in 8 (25%) women was there documentation of reasons for declining. 5 (12.5%) women were re-offered screening at about 28 weeks gestation in line with local policy with 4 (80%) accepting. 6 of 18 women were offered testing on admission to the labour ward and 2 (33.3%) were tested.DiscussionThe maternity unit has a policy for dealing with women declining HIV testing in pregnancy and achieved a 99.6% acceptance rate. This study shows that there are some problems with documentation of previous testing, risk assessment and consistently re-offering of the screening tests later on in pregnancy. When the test was re-offered later on in pregnancy there was a high acceptance rate emphasising the benefit of this approach. In view of these results further training of midwives with an emphasis on HIV risk assessment and re-offering testing later on in pregnancy will be implemented.

Advocating for Change in Medical Legislation

Advocacy is becoming an increasingly important role for physicians, and there is extraordinary value to becoming effective advocates on behalf of our patients. Until recently, advocacy was not a formal part of medical school or residency curricula. The American Academy of Pediatrics (AAP) has published an extensive overview of advocacy for the pediatrician.1 This online guide breaks down legislative reform efforts into individual, community, state, and federal levels. We focus here on state and federal legislative advocacy, the practice of taking a position, and initiating actions in a legislative arena so as to deliberately influence policy choices.2 Health law can have a profound impact on a physician’s practice of medicine, and there is a general call for physicians to become advocates for changes in public policy.3 However, there is little in standard medical journals outlining how medical personnel may specifically advocate for changes in laws that affect our daily professional lives. We describe here a recent effort to change the law in Rhode Island regarding HIV testing in pregnancy and use that effort as a launching pad for broader discussions of how involvement in legislative change can be an important and rewarding process for hospitalists. In 2006, a 4-week-old term infant presented to our hospital with a chief complaint of fever and rash. On the second hospital day, after an accidental needle stick, the child’s HIV status was reported as positive. The child made a prolonged and gradual recovery.4 Two salient facts emerged from this case. First, the mother had been offered HIV testing while she was pregnant but had refused. Second, had she accepted testing, there is a strong likelihood that her infant would not have acquired the disease. Limitations in current state law allowed the infection to progress and motivated us to try change …

HIV testing in pregnancy: are we testing enough?

The crucial first step in the prevention of mother-to-child transmission of HIV is awareness of pregnant women of their HIV status. The aim of this study was to define the percentage of patients who received HIV tests between 2001 and 2007 in a German city hospital. In this retrospective cohort analysis at a University hospital in a German urban area, 12,873 deliveries were retrospectively analysed to determine whether an HIV test had been performed during prenatal counselling. The number of HIV tests performed increased significantly between 2001 and 2007 from 59.6 to 76.7%. On average, 69.9% of the analysed deliveries were tested for HIV. Although awareness of the importance of HIV screening in newborns has increased in recent years, the numbers are still unsatisfactory. Therefore, further education is necessary to prevent HIV infection in early pregnancy and avoid HIV mother-to-child transmission.

Fathers and HIV: considerations for families.

BackgroundFathers are intricately bound up in all aspects of family life. This review examines fathers in the presence of HIV: from desire for a child, through conception issues, to a summary of the knowledge base on fathers within families affected by HIV.MethodsA mixed-methods approach is used, given the scarcity of literature. A review is provided on paternal and male factors in relation to the desire for a child, HIV testing in pregnancy, fatherhood and conception, fatherhood and drug use, paternal support and disengagement, fatherhood and men who have sex with men (MSM), and paternal effects on child development in the presence of HIV. Literature-based reviews and systematic review techniques are used to access available data Primary data are reported on the issue of parenting for men who have sex with men.ResultsMen with HIV desire fatherhood. This is established in studies from numerous countries, although fatherhood desires may be lower for HIV-positive men than HIV-negative men. Couples do not always agree, and in some studies, male desires for a child are greater than those of their female partners. Despite reduced fertility, support and services, many proceed to parenting, whether in seroconcordant or serodiscordant relationships. There is growing knowledge about fertility options to reduce transmission risk to uninfected partners and to offspring.Within the HIV field, there is limited research on fathering and fatherhood desires in a number of difficult-to-reach groups. There are, however, specific considerations for men who have sex with men and those affected by drug use. Conception in the presence of HIV needs to be managed and informed to reduce the risk of infection to partners and children. Further, paternal support plays a role in maternal management.ConclusionsStrategies to improve HIV testing of fathers are needed. Paternal death has a negative impact on child development and paternal survival is protective. It is important to understand fathers and fathering and to approach childbirth from a family perspective.

Knowledge about HIV infection and acceptability of HIV testing among women delivered in Podkarpackie Province, Poland

Objective To assess the knowledge of pregnant Polish women regarding the risk of perinatal HIV transmission, the ways to reduce this risk, and the importance of HIV testing in pregnancy, as well as their willingness to be tested for HIV. Methods A multicenter survey was conducted with 2123 pregnant women from Podkarpackie Province using a 4-part questionnaire. Results Only 15.4% of the women, mainly those with higher education, correctly assessed the risk of perinatal HIV transmission; 61.9% showed adequate knowledge of perinatal HIV transmission, mainly older, well-educated, multiparas residing in towns; and 81.1% declared a willingness to undergo HIV testing, mainly well-educated primigravidas in the 26 to 30 years age group residing in towns. Conclusion These pregnant women from Poland, where prenatal HIV testing is rarely done, showed a limited knowledge of perinatal HIV transmission but a high willingness to undergo HIV testing.