Beginning in January 2004, screening tests for HIV are
to be offered to all pregnant women in the Netherlands on an 'opt-out' basis
to prevent transmission of HIV from mother to child.
Currently screening tests for hepatitis B and syphilis are offered to all
pregnant women at about the 12th week of pregnancy. Frequently an HIV test
is also offered at this time, but this is not standard practice at present.
The College of Healthcare Assurance in the Netherlands presented two options
for HIV screening of pregnant women. The first was to offer a rapid 30 minute
HIV test after obtaining informed consent in the standard way. The second
was to offer a standard laboratory HIV test on an opt-out basis with the
result becoming available after 7-10 days.
The midwife or obstetrician will routinely offer the HIV test together
with other tests such as syphilis and hepatitis B. The pregnant woman can
then refuse to have one or more of the offered tests. The State Secretary
stressed the importance of good counselling, which includes providing information
on the disadvantages as well as the advantages of a positive HIV test result.
In this way women can make an informed choice whether or not to be tested.
The State Secretary chose the second option because it fits best with current
screening test practice. Also the rapid 30 minute HIV test would produce
a significant number of false positive test results in this low prevalence
population, thus causing a lot of unnecessary concern.