The Importance Of Maternal HIV Testing: Why Should Every Pregnant Woman Get Tested?

One in seven people living with HIV in the United States, the CDC estimates, was never diagnosed — and that means that some pregnant women will be HIV positive without having a clue that they are infected. Unless they find out in a timely manner, HIV positive expectant mothers risk passing the virus onto their babies, something that is now preventable.

How can people live with HIV without knowing it?

The possibility that they could be HIV positive will simply never have crossed the minds of some people — the initial symptoms of a HIV infection are easily misinterpreted as a flu-like illness for which you don't need to go to the doctor, and additional warning signs of HIV can take many years to show up.

Other people will have contemplated the possibility that they do have the virus, because they've engaged in activities that can transmit HIV, but are scared. Scared of the stigma that surrounds HIV, scared of the virus and what it could mean for their health and life, and therefore ultimately so scared to be tested for HIV that they just don't. 

With the right treatment, however, HIV very much doesn't have to be a death sentence. Though antiretroviral therapy can absolutely cause some nasty side effects, the right HIV treatment means that your life with the virus is likely to last almost as long as it would have been without the virus. There's no doubt that antiretroviral therapy comes with a much better quality of life than untreated HIV, either. 

One time during which all women are routinely advised to be tested for HIV, however, is pregnancy — a time when your baby depends on your health right alongside you. Why is this recommendation made to every pregnant woman?

Why is HIV testing routinely recommended to pregnant women?

Routine HIV testing during pregnancy is important for the same reason your OBGYN, midwife, or other prenatal care provider will take your blood pressure, weigh you, and offer ultrasounds. HIV testing during pregnancy is important for the same reason your health care provider will ask you if you need help stopping smoking or drinking during pregnancy, offer guidelines on a healthy diet and dangerous foods to avoid during pregnancy, and tell you to take folic acid during the first trimester. It is important for the same reason you'll be asked to get booster shots when you're expecting.

HIV and other sexually-transmitted infections can have a serious impact on you, the outcome of your pregnancy, and your baby's future health. Screening for HIV, syphilis, and hepatitis C is recommended to all pregnant women in the US, while some risk groups will be advised to get tested for other sexually-transmitted infections, too — because if you do test positive, that will enable you to get the care you need, and your healthcare team to plan ahead. 

When during your pregnancy will you be offered a HIV test?

Pretty quickly, and not uncommonly even at your very first prenatal appointment. Should you indeed be HIV positive, it's best if you start treatment right away — both you and your baby will benefit. If you tested negative during your first appointment, you will also be retested during your third trimester to find out if you are still negative.

But I can't have HIV, so I don't need the test?

A huge stigma still surrounds HIV, and it's easy to be in denial about the possibility that you could already be living with HIV. 

In the United States, the most common ways to get HIV are sharing needles with an infected person when using IV drugs (used needles can harbor HIV for up to 42 days!) and having sex with an infected person. Yes, receptive anal sex carries a higher risk, but vaginal sex can certainly transmit the virus, too. 

We may associate HIV with people who lead extraordinarily risky lives — to put it plainly, junkies and promiscuous folks — but the truth is that anyone directly exposed to the blood, semen and pre-ejaculate, rectal fluid, vaginal fluid, or breast milk of someone with HIV might be infected. 

What happens if it turns out that I'm HIV positive?

Pregnancy is a really scary time to find out that you're HIV positive!

From the moment you find out that you have HIV, however, your healthcare team should rally around you to give you the best possible care. That will mean starting on an ART (antiretroviral therapy) regimen that is safe during pregnancy and managing any side effects you experience as effectively as possible. 

You'll coordinate your treatment with your healthcare team every step of the way, and can rely on them. However, some general things you should be aware of if you were diagnosed with HIV while pregnant include:

• Your partner should also be tested for HIV.
• Start on ART as soon as possible and keep taking it as directed. If you notice side effects, do not discontinue your treatment on your own! Speak to your healthcare team about the best way to manage them. 
• If you have undetectable or low viral loads around the time of your labor, you will usually be able to give birth vaginally. If your viral load is high or unknown, you will be advised to have a scheduled cesarean section. 
• Drugs like zidovudine, used during labor and delivery, help reduce the risk that HIV will be transmitted to your baby. 
• After your baby is born, they will be tested for HIV. Your baby will be treated for HIV for the first four to six weeks before being tested. 
• Can you breastfeed? Advice on this greatly varies, even across different US government agencies! Breast milk can transmit HIV, however, if your viral load is undetectable, the possibility of this happening practically drops to zero. Discuss the pros and cons with your healthcare team in detail and make an informed decision based on your personal situation. 

A final word

Routine HIV testing is there for every woman. For most, even if the idea that they should be tested bothers them, the negative results will provide peace of mind. Those women who test negative during the first trimester should, however, remember that they can acquire HIV at any point during their pregnancy and take appropriate preventative steps (including the testing of their partner). 

Should your test results bring you unwelcome news, a time in your life that would have been joyful can quickly become anxiety-filled, scary, and stressful. In addition to getting started with HIV treatment, you may want to consider counseling to help you deal with the emotional aspects of the diagnosis. In the meantime, try to remember that the diagnosis, no matter how upsetting, allows you and your baby to both get the care you need.