MANDATORY PRENATAL SCREENING FOR THE HUMAN-IMMUNODEFICIENCY-VIRUS - THE EXPERIENCE IN SOUTH-EASTERN FRANCE OF A NATIONAL POLICY, 1992-1994

Objective To evaluate the impact of the 1993 French National Policy wh ich made it mandatory to offer screening for the presence of human imm unodeficiency virus (HIV) to all pregnant women who planned to give bi rth, although women remained free to refuse the test. Design Successiv e surveys in April 1992 and May 1994 in south-eastern France. Logistic regressions were performed to identify factors which affected access to HIV testing for women who gave birth and those who terminated their pregnancy, and for each year of study. Main outcome measures Attitude s and access to HIV testing among pregnant women, irrespective of preg nancy outcome. Setting All obstetrics and gynaecology departments and abortion clinics in the region. Population 3497 women in 1992 (2775 wh o were delivered and 722 who chose termination) and 3407 in 1994 (2701 who were delivered and 766 who chose termination). The response rates were 82% and 88%, respectively. Results In 1994 of women who were del ivered, 73% had an HIV test, compared with 63% in 1992 (P < 0.001); ho wever of women who terminated their pregnancy, only 28% had an HN test , compared with 24.5% in 1992 (P not significant), although they were more at risk for HIV infection. Socioeconomic differences affecting ac cess to testing were reduced between 1992 and 1994, but only among wom en who gave birth. Conclusion Introduction of a policy which makes it mandatory to offer HIV screening to all women who intended to have the ir baby improved access to screening but did not improve the rate of p reventative counselling. A mandatory requirement to offer HIV screenin g should be extended to women who request termination of pregnancy.