Australian and New Zealand Journal of Obstetrics and Gynaecology 2005; 45: 365–367 365 Blackwell Publishing, Ltd. Original Article HIV screening in an antenatal clinic Uptake of HIV screening in an antenatal clinic Sonia GROVER and Claire PETTERSON Royal Women’s Hospital, Melbourne, Australia Abstract Objective: To assess the uptake of HIV screening in pregnant women attending a tertiary hospital antenatal clinic. Methods: An audit was undertaken in an antenatal clinic where HIV screening was routinely offered to all women following counselling. For the women offered HIV testing, note was taken whether the woman agreed to testing or refused, and if so, the reason for refusal. Results: Sixty eight percent of women who were offered testing opted to have the test performed. Thirty two percent of women decided against testing, with half of these reporting a recent (negative) HIV test result. Conclusions: Over 80% of pregnant women were willing to have HIV testing. Implications: With the introduction of recommendations that all pregnant women be given the opportunity for HIV screening, a high participation rate can be expected from women who are offered testing, with the potential for minimisation of vertical transmission by identification of HIV positive women. Key words: antenatal, HIV, pregnancy, screening. Introduction In the past, HIV testing was only offered to those perceived at high risk of exposure. This was in line with the HIV/AIDS prevention strategy of informed and purposeful testing because of the limitations of testing and the lack of evidence that treatments dramatically altered the course of the disease. However diagnostic tests now have very high specificity, although false positives and indeterminate results can still occur in low prevalence populations. 1 Treatment options now available have also been demonstrated to be very effective. 2 From 1985 to 1994 testing of the female population dis- covered HIV positive cases that were sporadic with much lower detection rates than that of males. However notified cases of newly diagnosed HIV in women in Australia in 2001 was 13.5% 3 and has remained over 10% since then. 4 Thus, while the annual number of new diagnoses of HIV are falling overall, the proportion of women is increasing. In the majority of women who test positive for HIV the only identified risk factor is a history of unprotected heterosexual intercourse, 4 and this applied to the 48% (44/91) of Australian mothers whose children had a perinatal exposure to HIV. 5 In the context of pregnancy, the 25–30% risk for vertical transmission in industrialised countries 6 can be dramatically reduced with a number of effective interventions. These interventions include the use of antiretrovirals in the perina- tal period 2,7 and elective caesarean-section, 8 with a reduction of the risk of vertical transmission of HIV to the fetus to < 2%. 7,8 For these reasons screening is now considered appropriate to be offered routinely to all pregnant women. This is supported by the RANZCOG College Statements that recommend screening be offered to all pregnant women after appropriate counseling. 9 Studies to assess the uptake and acceptability of universal antenatal HIV screening in pregnant women have demon- strated that offering all women testing is not associated with increased anxiety, 10 results in increased screening and is welcomed by women particularly when they become aware of the potential benefit to their baby. 11–13 Where women are offered HIV testing a number refuse to be tested. We undertook an audit of the uptake of HIV infection screening at the Royal Women’s Hospital, Melbourne within an antenatal unit that offered screening routinely from 1999, before this was widely practised within the remainder of the hospital, to examine: 1 The acceptance of HIV screening in antenatal patients attending a public hospital outpatient department. 2 Reasons given for refusing HIV screening. The authors have no commercial, financial or funding interests. Current address of Mercy Hospital for Women, Studley Road, Heidelberg, Victoria, Australia. Correspondence: Associate Professor Sonia Grover, Suite 6, Warringal Medical Centre, Heidelberg, Victoria 3084, Australia. Email: sonia.grover@rch.org.au Received 16 February 2005; accepted 27 April 2005.