A review of HIV testing policies and procedures for pregnant women in public maternity units of Porto Alegre, Rio Grande do Sul, Brazil

Abstract

HIV/AIDS is considered one of the major public health issues in Brazil, with 120,399 notified AIDS cases by 1998 (Aristedes Barbosa et al., 1998). Rio Grande do Sul (RS) reports the highest HIV prevalence in women in the country (Louireiro et al ., 1998) and local serosurveillance studies note an increase in HIV prevalence in pregnancy from 2.6% in 1996 (Buchalter et al., 1996) to 3.3% in 1997 (Ferreira & Valente, 1997). As a result, the Ministry of Health has recommended that all pregnant women are offered an HIV test. This study reviewed HIV testing policies and procedures, reported by obstetric staff in public health care centres in Porto Alegre. The beliefs and practices of obstetric health care professionals towards HIV testing and prevention for pregnant women were also examined, given the crucial role of obstetric staff in the implementation of successful antenatal HIV testing procedures. In total, 106 (69.3%) of eligible obstetric health care professionals responded to a postal questionnaire during April and June 1998. Eighty-six (83.5%) of respondents reported a policy of universal offer of HIV testing. A few reported selective offer (n = 9, 8.7%) and eight (7.8%) reported a policy of testing on request only. When selection was operational, respondents reported aiming at women who disclosed intravenous drug use (88.9%), women whose partner had a history of injecting drugs (77.8%), recipients of blood products prior to 1985 (66.7%), women who reported one or more sexually transmitted diseases (STDs) (88.9%) and women whose current or previous partner ever had sex with a man (77.8%). Respondents reported that consent for an HIV test was acquired 'verbally' by the majority (n = 90, 88.2%), whilst ten (9.8%) acquired consent in writing. Two (2.0%) reported that woman's consent for an HIV test was not asked for. Units with universal antenatal HIV testing policy were significantly more likely to have had pregnant women test HIV-positive compared with non-universal policy units (U = 13.500, p = 0.050). It appears that whilst the majority of the public health centres were offering an HIV test to all pregnant women in Porto Alegre by 1998, a lack of structured auditing of the actual uptake of HIV testing by pregnant women still remains. Local HIV testing strategy would greatly benefit from such data.