The testing programme was conducted during February to April 1998. Before their booking appointment, all women were sent a leaflet about blood tests to be conducted, including HIV testing. At the antenatal clinic they were offered an HIV test by midwives who had been trained to use a printed discussion protocol that emphasised the benefits and presented the test as routine, making it clear that the woman could decline. As with the other blood tests, consent was given orally. The midwives noted uptake, time taken to discuss the test, and whether the woman or her partner was at risk of HIV from injecting drug use (this used to be the main local source of HIV transmission, although sexual transmission now predominates4
). Women were then asked to complete a questionnaire measuring attitudes, satisfaction, anxiety,5
knowledge about the test, and reasons for agreeing to or declining the test. Key outcomes were compared with those observed in the same setting during 1996-7.3
Of the 924 women who booked at the clinic, 816 (88.3%) had an HIV test; one woman not at high risk was found to be HIV positive. One woman was already known to be HIV positive and was not tested. The prevalence of HIV positivity was therefore 2/817 (0.2%). The mean time taken to offer the test was 2 minutes 34 seconds (range 1-15 minutes). One of the eight women at high risk because of injecting drug use declined to be tested.
The questionnaire response rate was 99.1% (916/924). Most women (793/904 (87.7%)) answered yes to the question, “Do you think the HIV test should be a routine test like all the other blood tests during pregnancy (i.e. it’s done unless you say you don’t want it)?” The mean anxiety score was 33.2 (SD 10.6; maximum possible 80). A question about reducing vertical transmission with zidovudine elicited a correct response by 69% of women (628/905). The most frequent reasons given for declining the test were, “Not necessary as I’ve no chance of being positive” (n=28) and “I’ve been in a stable relationship for a long time” (n=15).