The SOGC provides the following public education pamphlets designed for patients, clinics and health-care facilities. This material has been reviewed and endorsed by the SOGC’s subject matter experts.
HIV Testing in pregnancy
A virus called HIV (human immunodeficiency virus) causes infections and diseases which harm a person's immune and nervous systems. As people become sicker with HIV infections, they may be diagnosed with AIDS (acquired immunodeficiency syndrome). There is still no cure for AIDS. This makes HIV infections a serious health threat to every person.
Many people infected with HIV don't know they have it because they have never been tested for the presence of the virus in their blood. Another reason they may not know they are HIV positive is because it can take five years or more for the symptoms of' the infection to show up. When a persons blood contains HIV, the person is said to be HIV positive.
HIV damages the nerves and brain, the nervous system. It also attacks and destroys the body's natural defence system against disease-the immune system. Specifically, HIV destroys the CD4 cells of the immune system. Without enough of these special cells, the body has difficulty fighting off infections. When the immune system becomes so weakened by the attacking virus that certain life-threatening infections set in, and if the CD4 cell count is low in the person's blood, the person is said to have AIDS.
While it is true that an HIV infection has no cure, treatment is available today that can help people enjoy an improved quality of life and live longer. Treatment can also help lessen the risk of passing the virus to an unborn child.
HIV, Women and Their Children
The number of women of childbearing age who are infected with HIV is increasing. A pregnant woman can pass HIV to her unborn baby. Many babies infected with HIV die within three years unless they are treated. Today, there is a treatment to reduce the risk of passing HIV from an infected mother to her baby. That is why every woman thinking about becoming pregnant, and those women who are already pregnant, should strongly consider being tested for HIV. If you are unsure, talk with your health provider and read this pamphlet to find out more about HIV, AIDS and pregnancy. In addition, consider talking with a counselor in your community who specializes in HIV.
Every pregnant woman in Canada should be offered HIV testing during pregnancy. If your doctor doesn't mention testing you for HIV before you get pregnant or during your pregnancy-ask to be tested.
How HIV is Passed From Person to Person
HIV is found in an infected person's body fluids, semen, blood, vaginal secretions and breast milk. Most commonly, the virus is spread from an infected person to a non-infected person during sex. However, the virus can also enter a person's bloodstream by way of a contaminated needle if you share needles with an HIV positive intravenous drug user. An infected mother can pass the virus to her baby during pregnancy, delivery or while breast-feeding. Very rarely (in Canada the blood supply is carefully screened for the presence of disease and is considered very safe) can an HIV infection occur from a blood transfusion.
Checklist for Protection
Things you can do to protect yourself from becoming infected with HIV:
- Use a latex condom each and every time you have sex, learn how to use them properly by reading the instructions on the package and carry them with you all the time.
- Limit the number of sexual partners you have, the more partners you have, the greater the risk for getting HIV and other sexually transmitted diseases (STD).
- Don't take part in risky sex, the most unsafe is vaginal or anal sex without the protection of a latex condom.
- Ask questions about your partner's sexual history, who you have sex with, in this era of AIDS, should not be a casual decision. Instead, the decision should be given a great deal of thought. It is important to know the sexual and drug use history of the person you are sleeping with. Ultimately, it is best to test before having sex and keep talking about monogamy and safe sex during your relationship.
- If you use injectable drugs, use clean needles never share needles with anyone.
Testing for HIV
Most people cannot be completely sure whether or not they have been exposed to HIV and this by itself is good reason to be tested. Testing for the presence of the virus in your blood is usually done by way of blood test.The first test used is the enzyme-linked immunosorbent assay (ELISA). It is a test to see whether your blood contains HIV antibodies. Antibodies develop after a person has been infected. If HIV antibodies are present, it means that you are HIV positive. It does not mean you have AIDS. If the first test is positive, a repeat ELISA test will be done, and then a second test (called a Western blot) will be done to make sure there were no mistakes. Although it is extremely rare (about 1 out of every 20,000 tests,) a test may give a false-positive result.. A false-positive test says you are infected when you are not. If there are any doubts, you can be retested.
If Your Test Result is Negative
If your test result is negative, it only means the test did not find any HIV antibodies in your blood at the time of testing. This can mean one of two things:
- You are truly negative
- Or, you may be positive but there were not enough antibodies in your blood to measure at the time of the test. This can happen if your test was done so soon after you were infected that your body didn't have enough time to develop enough antibodies to measure. (It takes about 6-12 weeks after exposure to the virus to develop enough antibodies to measure.) In this situation, the test may have indicated you are not infected when you are. This is known as a false-negative test result. For this reason, some people choose to be tested again in 6 months.
Remember, even though a test result is negative, you can still become infected at any time after the test was done if you are exposed to the virus. You should always take precautions against HIV.
If Your Test Result is Positive
If your test result is positive, you will need guidance, emotional support and special health care-particularly if you are pregnant. Remember a positive test result does not mean you have AIDS. It means you have been infected with the virus that causes AIDS. It does mean that as a carrier of HIV you can pass it on to other people. For many, it is comforting to know that a great deal of medical research over the past decade has produced some very beneficial treatments which have helped HIV positive people to live healthier, longer lives.
Privacy During Testing
If you wish, you can ask to have your name left off the test tube and paperwork. This common request is called a non-nominal test. In this case, you will be assigned a "code number" for testing purposes, that only you and your doctor will know. The results will be placed in your medical file.
Only certain health care professionals will know the results or have access to your results. In some provinces, health care authorities are notified confidentially.
HIV and Pregnancy
About 0.2% (2 of every 1,000 women) of pregnant women are HIV positive. Of them about 1/3 (one out of every three) will pass the virus to their baby before it is born if no treatment is given. This is because the virus can cross to the baby from the mother's bloodstream through the placenta--as early as a woman's 8th week of pregnancy. In addition, an HIV positive mother can pass the virus to her baby at the time of' the baby's birth---when there is an exchange of body fluids. It may not make a difference whether a woman delivers a baby vaginally, or by caesarean section, since in many cases the fetus may have already been infected with HIV before its birth.
HIV and Breast-feeding
HIV is found in breast milk and therefore HIV positive mothers can pass the virus on to their nursing babies. Even mothers who tested negative for HIV during their pregnancy can still pass the virus on to their babies if they become newly infected during the period of time they were breast-feeding. Mothers infected with HIV, or those who continue to have risk activities associated with HIV infections, should formula feed their babies.
Treatment for Positive HIV Test Result in Pregnancy
If you are pregnant and you decide to go on with the pregnancy, you can lessen the risk of passing the virus on to your unborn child by up to 60%. Studies have shown that when HIV positive women (with no symptoms of AIDS) are given a drug (pill) called AZT (zidovudine) while pregnant, and during their labour and birth, they are much less likely to pass the virus to their fetus. You may need to continue taking it after the baby is born-depending on your health status. AZT will also be given to your newborn baby until he or she is six weeks old. This drug can cause some side effects. Therefore, it is very important to tell your doctor all the symptoms you may be having so that your doctor can bc sure you get the proper care. Without AZT treatments, the chances of your baby becoming infected are one in four (25%). With the treatments, the chances drop to one in twelve (8%). Another option is to end the pregnancy.
Additional Testing During Pregnancy
If you are HIV positive, your doctor will want to test you to see if you have other infections because your immune system (your disease fighting system) may be weakened. In particular, he or she may test you for other sexually transmitted diseases (STD). In addition, your HIV viral load and your CD4 cell count will be carefully monitored throughout the pregnancy. A lowered CD4 cell count and a high viral load cause an increased chance of passing the virus to the fetus.
Drug therapy treatment is available to help prevent the spread of HIV to your unborn baby.
A positive test result is a very frightening event for almost everyone. During such a difficult time in a person's life, counselling can be very helpful. A trained counsellor will not only give you emotional support you will need, he or she will teach you about HIV and help you to learn ways to cope with the disease. In addition, counselling is a very important part of helping you learn ways to avoid passing the virus on to someone else.
Medical researchers, and many famous AIDS activists have increased the awareness of AIDS tremendously over the past few years. As a result, people tend to focus on living with HIV in a more positive light and much of' the stigma attached to being HIV positive has subsided. Nowadays, people are getting tested more often in order to begin early treatment. That being said, HIV infections continue to be a threat to people all over the world, including children. If you are thinking about getting pregnant or are already pregnant, it is best to test!