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close this bookHIV in Pregnancy: A Review (UNAIDS, 1999, 67 p.)
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View the documentEXECUTIVE SUMMARY
View the documentINTRODUCTION
close this folderSECTION A : HIV IN PREGNANCY
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View the documentEpidemiology of HIV
close this folderSusceptibility of women to HIV infection
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View the documentBiological factors
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View the documentEffect of pregnancy on the natural history of HIV infection
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close this folderMother-to-child transmission
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View the documentFactors affecting mother-to-child transmission of HIV-1
View the documentInterventions to prevent mother-to-child transmission of HIV
close this folderAppropriate interventions to reduce mother-to-child transmission
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View the documentAntiretroviral therapy
View the documentImmune therapy
View the documentNutritional interventions
View the documentMode of delivery
View the documentVaginal cleansing
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close this folderVoluntary HIV counselling and testing in pregnancy
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View the documentTesting of antenatal women
View the documentCounselling before and after HIV testing in pregnancy
View the documentCounselling about pregnancy-related issues
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close this folderAntenatal care
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View the documentObstetrical management
View the documentExamination and investigations
View the documentMedical treatment during pregnancy
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View the documentUniversal precautions
close this folderRisks of needlestick injuries
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View the documentManagement of needlestick injuries and other accidental blood exposure
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Counselling before and after HIV testing in pregnancy

Pre- and post-test counselling are essential elements of the management of HIV in pregnancy. Pre-test counselling enables women and men to make informed decisions about an HIV test. Post-test counselling is an integral part of the management of the HIV-positive person, and provides an important opportunity for risk-reduction messages for those found to be HIV-negative.

Pre-test counselling

HIV testing should be accompanied by the provision of pre-test information and by informed consent to the test by the woman (see Table 5). Pre-test counselling implies explanation of both the test and the illness to the woman in a non-directive manner, and answering any questions prior to the performance of the test. The woman should be given time to decide on the test and, if unsure, should be counselled to take more time to think about the test and return at a later stage. Information about HIV testing can be incorporated into the health education and promotion activities of antenatal clinics and need not be too time consuming within maternity services319. Various models have been tried, including group counselling, video education, incorporating information on HIV into the first visit interview by midwives and the use of lay counsellors344,345. An appropriate model should be developed for the circumstances of each service, based on the prevalence and the level of prior awareness of the women in the community.

Table 5 : Pre-test counselling
[Based on guidelines from the Johannesburg Community AIDS Centre]

Take client to private setting for counselling
Assure the client of confidentiality
Explain or determine the reasons for HIV testing
Elicit information about the person's current and previous risk behaviour in a sensitive manner
Provide information about HIV and AIDS
Provide information about the HIV antibody test, including information about the "window period" of infection
Review the implications of a positive test result for the client
Discuss the person's possible responses to a positive test result
Discuss the implications of a negative test result
Provide information about test procedures
Obtain informed consent

Post-test counselling

The essential elements of post test counselling for HIV positive women are illustrated in Table 6. Counselling implies more than merely giving a positive result, and continued care and advice will be necessary as part of the management throughout the pregnancy and beyond344,346,347. The choice of appropriate counsellor will depend upon the circumstance of the practice or health service: counsellors ideally should have personal qualities, which equip them for the job, but many of the skills can be acquired during training. Wherever possible, counselling should be provided in the woman's home language and within the same cultural background. The involvement of peer counsellors - women who are themselves HIV-infected, who are able to counsel and to share their own experiences, fears and successes may be very valuable and should be encouraged. The integration of peer counsellors and support groups into the work of health services can be a very valuable addition to the available services.

Table 6 : Post-test counselling
[Based on guidelines from the Johannesburg Community AIDS Centre]

See the client personally to give result - no telephonic results, preferably not before a weekend
Give the result as soon as possible after the test is done
Inform the client of the test result
Deal with the feelings arising from a negative result and explore prevention of infection and the window period
Deal with the feelings arising from a positive result
Identify the person's immediate concerns
Discuss how the client plans to spend the next few hours and days
Identify what support the client has
Discuss who the client may want to tell about the result and risks to sexual partners
Identify what difficulties or problems the client foresees and how to deal with them
Encourage the client to ask questions
Provide information on a healthy lifestyle, medical follow-up, local support systems
Refer for follow-up care and counselling

The delay between taking the test and giving the result should be as short as possible, as the woman may be very concerned about the test and the implications of the result. Women who test positive should be encouraged to bring their male partner(s) for counselling and testing wherever possible.

Post-test counselling should also be provided for HIV-negative women, with a focus on providing information to enable them to avoid infection. This could be provided on a group basis, or by individual health workers, depending on the circumstances.