After years of turning down the requests of AIDS experts that all pregnant women be tested for HIV, the Health Ministry has finally decided to recommend the test to all pregnant women and not only to those at high risk for the disease.
Until now, the reasons given by the ministry for offering the test only to women at high risk for HIV were that it was “too expensive” to test all pregnant women and that the number of HIV carriers and AIDS patients was ”small” here.
A few weeks ago, a baby died at Hadassah University Medical Center in Jerusalem because she was infected at birth and possibly through breastfeeding by her mother – who was unaware that she was a carrier. Because the mother was not found to be positive and not given the drug “cocktail” in pregnancy that can prevent nearly every case of infection of the baby, the infant died.
Every year, three or four babies are infected with HIV.
The ministry confirmed to The Jerusalem Post that it “has been discussing” mandatory tests, just as it tests all pregnant women for syphilis, and it has now decided to recommend them to all pregnant women. The ministry did not give the apparent reason for the change – its decision that from January 2014, the health funds would pay for HIV testing and not the ministry itself.
Dr. Daniel Elbirt, a senior physician at Kaplan Medical Center’s AIDS center in Rehovot, said he thought the transfer of responsibility for payment from the ministry to the health funds was the reason for the change in policy.
Elbirt, the former secretary of the 40-member Society of AIDS Physicians, said that he and his group pushed for years for the mandatory testing of pregnant women. It was only optional, offered to “high-risk women – meaning those who come from countries where AIDS is endemic, prostitutes and drug-takers.
It was opt-in, and not opt-out, in which all women were offered the test and those who agreed would be tested. Some women who were offered tests for being in these categories refused to do it, as it carries a stigma.”
But Elbirt said that if every pregnant woman were automatically given the test, there would be no stigma. It is given throughout the Western world and has been recommended by the World Health Organization and other important health authorities.
Although the HIV test is not expensive (significantly below NIS 100 each), even when it was much higher it would have paid to administer it, said Elbirt.
“Any baby who is infected will need to get the drug cocktail, which costs NIS 6,000 a month for the rest of its life – for some 80 years – which comes out to a huge amount.
In addition, a test early and perhaps also late in pregnancy could, if positive, lead to the women getting the cocktail and turn HIV into a manageable chronic disease. Her partner could also be warned, to prevent him from getting infected or to treat him if he is,” the Kaplan doctor said.
There is almost complete success in preventing babies from contracting HIV from their mothers at birth, when the fetus passes through the birth canal, and from breastfeeding.
The woman will then be given protease inhibitors during pregnancy to fight the virus, and she will be advised not to breastfeed.
No comment was available from the ministry, which said that “the only one who could answer,” Prof. Itamar Grotto, head of public health services, was abroad. But the ministry did confirm that it had decided to recommend testing of pregnant women.