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Routine HIV testing of all pregnant women in Oman has been introduced without prior knowledge of women's attitudes towards testing or their behaviour in the event of a positive test. This study recruited 1000 Omani pregnant women from antenatal clinics to explore their knowledge of HIV/AIDS, attitudes towards HIV testing and intended behaviours in the event of a positive test. Mother-to-child transmission was recognized by 86.6% of the women but only 21.0% knew that it was preventable and a few acknowledged the important role of antiviral drugs. Half of the women (51.9%) reported having been tested for HIV and 75.8% agreed about routine HIV testing for all pregnant women. A higher level of knowledge was significantly associated with a favourable intended behaviour related to voluntary testing, disclosure and seeking professional assistance in the event of a positive HIV test. The results are discussed in relation to opt-in and opt-out approaches to voluntary testing during pregnancy.

An estimated one fourth of persons with human immunodeficiency virus (HIV) are not aware they are infected. Early diagnosis of HIV has the potential to ensure optimal outcomes for infected persons and to limit the spread of the virus. Important barriers to testing among physicians include insufficient time, reimbursement issues, and lack of patient acceptance. Current HIV testing guidelines address many of these barriers by making the testing process more streamlined and less stigmatizing. The opt-out consent process has been shown to improve test acceptance. Formal pretest counseling and written consent are no longer recommended by the Centers for Disease Control and Prevention. Nevertheless, pretest discussions provide an opportunity to give information about HIV, address fears of discrimination, and identify ongoing high-risk activities. With increased HIV screening in the primary care setting, more persons with HIV could be identified earlier, receive timely and appropriate care, and get treatment to prevent clinical progression and transmission.

The first HIV-1 marker that appears in blood following infection is HIV-1 RNA and usually the load is in millions of copies/ ml preceding seroconversion. A 24-year-old pregnant woman, gravida 2, parity 1 was tested for HIV as part of antenatal screening. Three samples were collected and tested from this individual over a period 70 days. The HIV-1 RNA level during seroconversion phase was very low, contrary to the well understood natural history of HIV infection. The reactivity rate in the ELISA and the Western Blot profile showed a gradual increase over the 70 days with a weak reactivity in a second generation assay (detects IgG only) for the third sample. This case illustrates the uncertainties regarding the serological window period in HIV infection and the need to use at least a third generation assay in testing centres for early detection of HIV infection.

Obstetrician-gynecologists provide comprehensive primary and preventive care for women and are ideally suited to provide human immunodeficiency virus (HIV) screening for their patients. This paper provides a summary and rationale for the current recommendations for HIV testing among women in the United States, emphasizing recommendations from the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists [corrected] Who should receive HIV testing, when and how often testing should be conducted, and how testing should be offered are discussed. These recommendations are described separately for general populations (including nonpregnant women) and for pregnant women and their infants.

Despite recent advances in ways to prevent transmission of HIV from a mother to her child during pregnancy, infants continue to be born and become infected with HIV, particularly in southern Africa where HIV prevalence is the highest in the world. In this region, emphasis has shifted from voluntary HIV counselling and testing to routine testing of women during pregnancy. There have also been proposals for mandatory testing. Could mandatory testing ever be an option, even in high-prevalence settings? Many previous examinations of mandatory testing have dealt with it in the context of low HIV prevalence and a well-resourced health care system. In this discussion, different assumptions are made. Within this context, where mandatory testing may be a strategy of last resort, the objections to it are reviewed. Special attention is paid in the discussion to the entrenched vulnerability of women in much of southern Africa and how this contributes to both HIV prevalence and ongoing challenges for preventing HIV transmission during pregnancy. While mandatory testing is ethically plausible, particularly when coupled with guaranteed access to treatment and care, the discussion argues that the moment to employ this strategy has not yet come. Many barriers remain for pregnant women in terms of access to testing, treatment and care, most acutely in the southern African setting, despite the presence of national and international human rights instruments aimed at empowering women and removing such barriers. While this situation persists, mandatory HIV testing during pregnancy cannot be justified.

Objectives: To establish whether the Determine (Abbott, Tokyo, Japan) HIV antibody test is suitable as an on-site rapid HIV test at primary health care centres by determining its sensitivity and specificity compared with the standard enzyme-linked immunoassay (ELISA) test., Design: Prospective field evaluation study of a rapid HIV test compared with an ELISA., Setting: KwaDabeka clinic and St Mary's Hospital, urban primary health care clinics in the Durban western metropolitan area., Subjects: Women attending antenatal clinics and those presenting at onset of labour., Outcome Measures: Performance of the rapid test versus conventional ELISA testing, sensitivity, specificity, feasibility of implementing the test at primary health care clinics, prevalence of HIV infection at study sites and its association with patient booking status., Results: A total of 323 specimens were tested from patients from two community clinics, KwaDabeka (N = 159) and St Mary's (N = 164). The overall HIV prevalence was 45.5%. There was a significant difference in HIV prevalence (P < 0.001) between KwaDabeka (35.2%) and St Mary's (55.5%). Of the participants 49.2% were from KwaDabeka clinic and 50.8% from St Mary's Hospital. Overall, HIV prevalence among unbooked participants was 43.0%, and among booked participants 46.3%. This was not statistically different (P = 0.612) between the two clinics. The rapid test showed a sensitivity and specificity of 100% when compared with a conventional diagnostic ELISA test., Conclusion: The Determine rapid HIV antibody test is sensitive, specific, easy to perform and provides a valuable method for HIV testing especially in settings with limited access to laboratory infrastructures and trained laboratory staff.

These guidelines replace CDC's 1995 guidelines, U.S. Public Health Service Recommendations for Human Immunodeficiency Virus Counseling and Voluntary Testing for Pregnant Women, and are for public- and private-sector service providers who provide health care for pregnant women. In 1998, the Institute of Medicine (IOM) published a report that recommended simple, routine, and voluntary human immunodeficiency virus (HIV) testing for all pregnant women in antenatal settings, given the effective interventions available to treat HIV-infected women and reduce risk for perinatal HIV transmission. In 1999, CDC convened consultation groups to discuss and comment on the IOM report. These guidelines are based on input from these meetings, the IOM report, and public comment on draft guidelines published in Fall 2000 in the Federal Register. These guidelines were also prompted by scientific and programmatic advances in the prevention of perinatally acquired HIV and care of HIV-infected women. These recommendations are consistent with the Revised Guidelines for HIV Counseling, Testing, and Referral. Major revisions from the 1995 guidelines include: emphasizing HIV testing as a routine part of prenatal care and strengthening the recommendation that all pregnant women be tested for HIV; recommending simplification of the testing process so that pretest counseling is not a barrier to testing; making the consent process more flexible to allow for various types of informed consent; recommending that providers explore and address reasons for refusal of testing; and emphasizing HIV testing and treatment at the time of labor and delivery for women who have not received prenatal testing and antiretroviral drugs. These guidelines recommend voluntary HIV testing to preserve a woman's right to participate in decisions regarding testing to ensure a provider-patient relationship conducive to optimal care for mothers and infants and to support a woman's right to refuse testing if she does not think it is in her best interest.

The promising findings of ACTG 076, which identified a hopeful strategy for substantially reducing HIV transmission from mother to fetus, has stimulated a debate on counseling and testing protocols for pregnant women. This article presents an analysis of five state policy alternatives that address HIV counseling and testing. The policy analysis utilizes vertical and horizontal equity, user preference including avoidance of stigma and the right to privacy, effectiveness, and feasibility as evaluative criteria for examination of the policies. Interviews with state health department personnel enhance the policy analysis. While universal HIV counseling and voluntary testing for pregnant women emerges as the most acceptable policy, public health professionals must assume a vital role in facilitating the adoption of ethical and just state policies in an atmosphere sometimes hostile to women at risk for HIV.

Unlabelled: OBJECTIVE--To describe the identification of human immunodeficiency virus (HIV)-infected infants born to women who were seronegative or indeterminate during pregnancy. RESEARCH DESIGN--Longitudinal cohort study. SETTING--Inner-city medical center., Participants: A series of children born to women with histories of risk factors for HIV infection were followed up for studies of the natural history of HIV-infected infants. These children were identified through risk factor assessment of pregnant women presenting for obstetric care. INTERVENTIONS--Counseling and testing to detect HIV. RESULTS--Three women were retrospectively identified who were infected with HIV during pregnancy but whose test results showed them to be either seronegative or indeterminate. Two of these women transmitted HIV infection to their children. Subsequently, all three women were confirmed to be infected. CONCLUSIONS--Standard serologic testing to detect HIV infection will not identify all infected pregnant women. Perinatal transmission of HIV can occur in women with negative results of enzyme-linked immunosorbent assay or indeterminate results of Western blot analysis during pregnancy.