Women and Their Children

In Canada, 10% of people with HIV are women (see Special counselling issues for women). The most common way that women are infected is through unprotected sexual activity with men. However, sharing of drug-injecting equipment is a rapidly growing mode of transmission.

Some manifestations of HIV infection in women may differ from those in men. (3)

Lesbian and bisexual women should not be excluded from testing for HIV and counselling: they may have past or current risk factors.

Risk factors for HIV infection should be assessed and testing offered routinely at visits for Pap tests and consultations about contraception or STDs.

Mother-to-child transmission

About 14% of uninfected infants who are breast-fed by HIV-positive mothers will become infected. Therefore, breast-feeding by HIV-positive mothers is generally discouraged in Canada.

Testing an infant's blood for HIV cannot show whether the infant is infected, but will indicate the mother's status. All infants of HIV-positive mothers will test positive at birth because the mother's HIV antibodies cross the placenta to the infant; they may persist in the infant's blood for 15 months or more.

Other methods, such as HIV culture and tests to detect HIV antigens (such as p24 antigen assay) or HIV genetic material (polymerase chain reaction [PCR]), must be carried out to determine whether an infant is infected.

A multicentre study showed a dramatic reduction in mother-to-child transmission of HIV from 25.5% to 8.3% following zidovudine treatment (7). (Zidovudine or ZDV was formerly known as AZT.)

Prenatal testing procedures

At the first prenatal visit

• Follow the standard practice of exploring desirability of pregnancy, presence of social support, living situation and stability of relationship.
• Discuss advantages and disadvantages of testing for HIV for both mother and child and discuss the availability of treatment to reduce the chance of transmission to the fetus.
• Provide information on mother-to-child transmission.
• Discuss strategies to reduce the risk of acquiring HIV and other STDs during pregnancy. Provide written material along with information about local resources.
• Provide a separate requisition for the HIV test, so that the woman may decide against HIV testing without jeopardizing other prenatal screening.

• If the woman has chosen not to be tested, explore and record the reason.
• If the woman has not yet decided, re-explore the advantages and disadvantages of testing during pregnancy.
• If the woman has chosen to be tested, obtain and record receipt of informed consent.

Pediatric testing for HIV

There is no need to prevent the placement of HIV-positive children in child care settings, including daycare centres, to protect personnel or other children because the risk of transmission of HIV in these settings is negligible. Universal precautions should be followed in all child care settings when blood or bloody fluids are being handled (8).

  Continue