|Counselling and Voluntary HIV Testing for Pregnant Women in High HIV Prevalence Countries - Elements and Issues (UNAIDS, 1999, 24 p.)|
|4. Counselling and voluntary HIV testing: a prerequisite for action|
Pre-test information and counselling for HIV-negative women: a summary
· Information to prevent future infections
· Importance of sustained and exclusive breastfeeding for infant health
In even the highest HIV prevalence countries, most pregnant women are not HIV-infected. For some, the process of testing will raise important and personal issues about sexual and domestic relationships that may need to be resolved through further discussion (perhaps with the partner). A negative result should never be presumed to identify a lack of anxiety or of a need for further counselling. Information and counselling for HIV-negative women should concentrate on preventing future infection.
Preventing future infections
Where couples have been tested together and both are negative, information given in pre-test counselling about prevention of sexual transmission of HIV should be reinforced and the particular importance of avoiding infection during pregnancy and breastfeeding should be stressed.
Research in Malawi suggests that women may be at high risk of HIV infection soon after childbirth. This may be because their husbands or partners have sex with other partners during a womans pregnancy or the abstinence that often follows it, becoming infected at that time and passing on the new infection as soon as sexual relations with the new mother resume. This represents a double danger if the mother is still breastfeeding, since there is a very high likelihood of transmitting infection to the infant when the mother carries the high viral load associated with new HIV infections.
Where a partner is infected, or where his serological status is not known, the importance of prevention information and counselling is greater still. Information on where to get condoms and other contraceptive means should be given.
Ensuring healthy feeding practices
A negative test result also creates an opportunity for the active promotion of exclusive and sustained breastfeeding among HIV-negative mothers.