HIV, Pregnancy and Testing
Natali Aziz, M.D., M.S
Natali Aziz, M.D., M.S. Clinical Assistant Professor, Director of Perinatal Infectious Diseases, Division of Maternal-Fetal Medicine in the Department of Obstetrics and Gynecology at Stanford University School of Medicine.
Dr. Natali Aziz has a deep interest in helping pregnant women learn their HIV status that is rooted in a passion for the prevention of perinatal transmission and the overall benefits of medical care for the mother. She has played an integral role in the Center for Disease Control's (CDC) One Test. Two Lives. program, participating in many initiatives since the program's conception. Most recently, she has been a key contributor for the One Test. Two Lives. perinatal curriculum for residency and nurse midwifery students. Dr. Aziz stresses that perinatal HIV education is a crucial component of both OB/GYN and midwifery training programs and is committed to increasing educational opportunities about this specific topic in these curriculums. She also believes perinatal HIV education should become a nationwide standard, integrated into trainings developed for residency programs. To promote One Test. Two Lives., and activities of similar focus, Dr. Aziz has served as a presenter, as well as participated in various panels that focus on HIV testing for pregnant women. She presented a study describing the findings of a survey of obstetric providers' HIV testing practices in clinical settings at the 2008 Infectious Disease Society for Obstetrics and Gynecology meeting in Seattle, WA.
Dr. Aziz actively supports CDC's HIV testing recommendations for women who are pregnant. She stresses that "the benefits of HIV testing are tremendous. If an HIV-infected woman does not know her status and is therefore not appropriately managed during pregnancy, the risk of transmission [to her unborn child] is 25%, [but] with early testing, appropriate treatment with HAART (highly active antiretroviral therapy), and achieving an undetectable maternal viral load, it can be reduced to less than 1-2%."
While Dr. Aziz supports testing, she does note that for clinicians, ensuring all patients are tested for HIV can prove to be difficult. Some common obstacles clinicians face include patient resistance to testing due to fear of HIV infection and stigma, and lack of knowledge on the benefits being treated. She also states that overcoming patient declination is another hurdle, especially if clinicians do not have the appropriate resources to demonstrate to patients the importance of being tested. These challenges are the reason Dr. Aziz is an advocate for CDC's One Test. Two Lives. : "The program is critical because it helps offer educational materials to inform patients…and utilizing patient educational materials is key to improving patient acceptance of HIV testing as a routine part of prenatal care."
Dr. Aziz explains that promoting the routine nature of perinatal testing can help both clinicians and patients overcome potential barriers. Her three very basic but key pieces of advice for implementing HIV screening during pregnancy include:
- Test all pregnant women as early as possible in pregnancy.
- Utilize an opt-out approach where possible.
- Test again in the third trimester and at time of labor (per Rapid HIV screening) as needed when pregnant women are at high risk for acquiring HIV infection and/or have an undocumented HIV status, respectively.
Dr. Aziz desires to make HIV testing a very routine and effortless part of prenatal care and to be involved in increasing OB/GYN resident knowledge about the importance of HIV perinatal management and One Test. Two Lives.