Mandatory prenatal screening for the human immunodeficiency virus: the experience in south-eastern France of a national policy, 1992-1994

Abstract

Objective: To evaluate the impact of the 1993 French National Policy which made it mandatory to offer screening for the presence of human immunodeficiency virus (HIV) to all pregnant women who planned to give birth, although women remained free to refuse the test.

Design: Successive surveys in April 1992 and May 1994 in south-eastern France. Logistic regressions were performed to identify factors which affected access to HIV testing for women who gave birth and those who terminated their pregnancy, and for each year of study.

Main outcome measures: Attitudes and access to HIV testing among pregnant women, irrespective of pregnancy outcome.

Setting: All obstetrics and gynaecology departments and abortion clinics in the region.

Population: 3497 women in 1992 (2775 who were delivered and 722 who chose termination) and 3407 in 1994 (2701 who were delivered and 766 who chose termination). The response rates were 82% and 88%, respectively.

Results: In 1994 of women who were delivered, 73% had an HIV test, compared with 63% in 1992 (P < 0.001); however of women who terminated their pregnancy, only 28% had an HIV test, compared with 24.5% in 1992 (P not significant), although they were more at risk for HIV infection. Socioeconomic differences affecting access to testing were reduced between 1992 and 1994, but only among women who gave birth.

Conclusion: Introduction of a policy which makes it mandatory to offer HIV screening to all women who intended to have their baby improved access to screening but did not improve the rate of preventative counselling. A mandatory requirement to offer HIV screening should be extended to women who request termination of pregnancy.