Talking about HIV
CMAJ 1998;159:920-1
I agree with the recommendation that HIV testing should be offered to all pregnant women, as set out in the article "Evidence-based guidelines for universal counselling and offering of HIV testing in pregnancy in Canada" by Drs. Lindy Samson and Susan King (CMAJ 1998;158[11]:1449-57 [full text / résumé]). However, as a family physician who is also a primary care provider for people with HIV, I think women would and should want to know their HIV status before they become pregnant. With the discovery of the remarkable benefits of zidovudine, more HIV-positive women are planning pregnancies. But the key word is "planning."
The health care issues for HIV-positive women are endless and not the focus of this letter. The point is that we, as family physicians and obstetricians who provide primary care to women, should be proactive. We should be asking women during their annual check-ups if they are planning a pregnancy (just because a woman takes a prescription for a year's worth of birth control pills doesn't mean she is going to use them all), and we should offer HIV testing when women ask if it's alright for them to become pregnant. Presumably, we are all talking about folic acid supplementation, smoking cessation, and avoidance of alcohol and drugs in this situation, so why not talk about HIV? The sooner we become more comfortable with discussing this topic, the better our prevention strategies will be.
Donna Keystone, MD
Bloor Medical Clinic
Toronto, Ont.
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