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J Obstet Gynaecol Can. 2003 Sep;25(9):751-9.

Mother-to-child transmission of HIV in Canada: a population health risk management perspective.

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Department of Family Practice, Division of Maternal and Newborn Care, General Campus, The Ottawa Hospital, Ottawa, ON, Canada.


The standard of prenatal care in Canada for preventing transmission of the human immunodeficiency virus (HIV) from mother to infant is universal counselling and voluntary testing of pregnant women for the virus. Appropriate treatment of HIV-positive women reduces the risk of viral transmission to the infant to less than 1%. Despite this, too many children in Canada are born with HIV because their mothers were not tested. The barriers to screening include lack of appropriate resources and lack of training in this area. As a result, physicians find HIV test-counselling too time-consuming or believe that testing is not relevant to their patient population. Risk management strategies to improve screening rates and decrease transmission, including community action and technological strategies such as vaccines and rapid testing kits, are reviewed. The "advisory" option, the process of risk communication between health-care providers, the government, and the public, for the purpose of making recommendations, is a key component toward the success of universal screening. A shift to simplified screening and "opt-out" testing procedures is recommended.

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