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-----Original Message-----
From: Sarah Davies [mailto:[log in to unmask]]
Sent: 27 February 2001 13:04
To: [log in to unmask]
Subject: Re: antenatal HIV testing
Dear Carolyn, Kevin and others interested in this debate -
I think Kevin Corbett is quite right when he points out that many midwives
find themselves in a dilemma when it comes to HIV testing.
I am a lecturer in midwifery at Salford and many midwives have approached me
expressing worries about the antenatal testing regime. In fact in response
to their concerns we held a conference on the issue and are holding another
on October 10th this year. Their concerns are varied but include; lack of
proper training/preparation for midwives (and in some areas midwives have
talked of being 'brainwashed' through inadequate training sessions where
they only receive partial information); lack of adequate information for
women resulting in women not being able to make a fully informed decision;
worries about breaches of confidentiality; the possibility of false positive
results (which are likely to be higher than true positives in areas of low
prevalence); reliability of the tests used; cost effectiveness and
risk/benefit ratio; and instances of abuses of women's rights and autonomy
by clinicians when supposedly 'at risk' women have refused the test.
The motives behind the idea of 'normalising' the HIV test are laudable but I
believe that midwives have made a mistake in supporting the government
directive for clinicians to recommend rather than offer the test. I also
feel we should not support the government drive for targets. The DoH might
have reasonably established a goal that a ll women be offered the test but
to try to insist that we reach a percentage uptake (90% by 2002) basically
amounts to coercion.
As George Kent (Professor of Political Science at Hawaii University) said in
a recent email:
'Pregnant women should be given the opportunity to be HIV tested on the
basis of informed consent. Clear standards should be adopted regarding what
information is appropriate and adequate. There should be an opportunity for
public discussion about what constitutes adequate information'.
I do not feel there has been enough public discussion, and I am pleased that
midwives are coming forward with their worries so that there can be more
open debate.
I wrote an article on HIV antenatal testing in the Sept. 2000 issue of
MIDIRS. Also if anyone is interested in receiving a copy of our conference
statement I will gladly send it.
Sarah Davies
Midwifery Lecturer
Directorate of Midwifery
University of Salford
Allerton Building
Frederick Rd
Salford
M6 6PU
Tel: 0161 295 2511
Fax: 0161 295 2501
Email:[log in to unmask]
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