HIV Testing During Pregnancy
Jan Kriebs, C.N.M., M.S.N., F.A.C.N.M.
Jan Kriebs runs a practice at the University of Maryland that includes a clinic for pregnant women who are HIV positive. She knows first hand the importance of testing a mother for HIV early in pregnancy. Her clinic delivers approximately 40 babies each year from pregnant women who are HIV positive with only a 1% transmission rate. The babies who are born HIV positive usually have mothers who acquired HIV during pregnancy or were not tested early enough. Through working with pregnant women living with HIV she has seen the beneficial impact on women who learn about their status early and receive healthcare and appropriate treatment.
"It's a very special time; moms living with HIV deserve for their birth to be just as special and just as happy as anyone else. The first step is getting the diagnosis at the right time."
--Jan Kriebs, on the importance of testing for HIV early during pregnancy
No place is immune to HIV
Kriebs joined the outreach efforts of One Test. Two Lives. to spread the word about HIV testing early in pregnancy to providers who are not regularly testing their patients. "Some healthcare providers will not have many positive patients, but that doesn't mean they do not have any," says Kriebs. The challenge is to reach the healthcare providers who will not see HIV very frequently in their practice and are therefore less likely to test, especially if they do not believe patients in their practice are at risk.
Many patients don't believe they are at risk for HIV or are scared to ask about getting a test. Jan observed that "It's human to shy away from asking questions you don't want the answer to." Kriebs tells her patients, "If you are diagnosed early and can work with us, there's only a 1-2% chance that your child will be HIV positive." Her experience working with patients supports her belief that increasing a women's understanding about the chances of reducing mother-to-child transmission will make her more likely to accept an HIV test. Healthcare providers need information to share with their patients about HIV testing in pregnancy like the brochures and fact sheets available in the One Test. Two Lives. provider resource kit.
Regardless of the information that patients have, it is important for healthcare providers to offer the HIV test. Kriebs says, "Motherhood really changes your life, and getting this diagnosis adds an extra hurdle," so it is easy to understand why a patient might be reluctant to ask for a test. A patient's hesitation to ask for a test or lack of knowledge makes it even more imperative for healthcare providers to offer the test to their patients. Kriebs points to the Perinatal HIV Hotline of the HIV/AIDS Clinicians' Consultation Center at the University of California-San Francisco as a resource for healthcare providers who want to learn more about talking to their patients about HIV testing. Learning how to talk to an HIV-positive patient can help both the provider and the patient. "Telling a pregnant woman she has HIV is not the same as sharing if the baby is a boy or a girl: it's a hard thing to talk about," says Kriebs.
Kriebs noted that telling a woman she is HIV positive means taking time to talk about what comes next, who she needs to notify, and who will be able to care for her; however, she believes that the benefit of preventing HIV transmission to the baby outweighs the extra time taken to talk to a woman about a positive diagnosis.
Spreading the Word
How does Kriebs propose reaching providers who think their patients are not at risk? "Just keep singing and hope the choir gets bigger," which is exactly what she is doing. She co-authored a piece in the Resource for Clinicians section of the Journal of Midwifery and Women's Health, Volume 53, Number 3, May/June 2008, "HIV Counseling and Testing in Pregnancy." Kriebs includes messages about perinatal HIV prevention in presentations she gives around Maryland and at national conferences such as her presentation, "Counseling and Testing: What every midwife needs to know about HIV" at the American College of Nurse Midwives annual meetings in 2008 and 2009. She has also included information about the One Test. Two Lives. campaign and preventing mother-to-child HIV transmission in the Maryland Perinatal Network newsletter.