Antenatal screening for HIV; are those who refuse testing at higher risk than those who accept testing?

Background The UK Department of Health recommends that all pregnant women are offered screening for infection with human immunodeficiency virus (HIV) and had encouraged maternity units to achieve uptake targets of 90 per cent by the end of 2002. Many maternity units fail to meet this target and there is concern that those women who are still refusing testing may include a higher proportion of women at high risk of infection. In consequence, those infected with HIV are not being identified and are not receiving the antiviral treatment, which would be of benefit to them and reduce the risk of transmission of HIV to their babies. Methods A retrospective audit of HIV screening uptake in women who were found to be infected with hepatitis B virus (HBV) and in those who were not infected with HBV was carried out in order to explore further the characteristics of 'acceptors' and 'refusers' of HIV screening. Results The overall uptake rate of HIV screening in the West Midlands population served by the National Blood Service was 60 per cent in 2001 and 74 per cent in 2002. The prevalence of HBV infection was found to be twice as high (0.39 per cent) in those who had refused an HIV test compared with those who had accepted a test (0.21 per cent) (p=0.022). Conclusions There is good evidence that women refusing HIV antenatal screening have a higher prevalence of another blood-borne virus, indicating clearly that further effort must be made to increase the screening uptake and fully integrate HIV screening with other antenatal tests.