Prevention of mother-to-child transmission of HIV in Thailand: Physicians'attitudes on zidovudine use, pregnancy termination, and willingness to provide care.

We administered a survey to Thai physicians, using regular mail, on their a ttitudes and practices regarding zidovudine (ZDV) use and pregnancy termina tion in HIV-infected pregnant women. We surveyed their willingness to care for these patients as well. In 1997, 79.5% of 480 respondents reported that they did not routinely use perinatal ZDV prophylaxis. Predictors of failur e to use ZDV found to be significant in our logistic regression model inclu ded practice outside of Bangkok (odds ratio [OR] = 2.0), belief that ZDV is not cost effective (OR = 2.5), unfamiliarity with AIDS Clinical Trials Gro up (ACTG) 076 results (OR = 2.5), and failure to screen for HIV routinely ( OR = 4.9). Elective abortion for HIV-infected women was advocated by 45.3% of respondents. Factors associated in multivariable analysis with this pref erence included specialty training in obstetrics/gynecology (OR = 1.8), pra ctice inside Bangkok (OR = 2.0), male gender (OR = 1.9), and treatment of l ess than or equal to 2 HIV-infected patients yearly (OR = 1.8), A significa nt proportion of respondents described themselves as unwilling to perform p elvic examinations (19.2%), vaginal deliveries (30.7%): or cesarean deliver ies (39.5%) on women who were known to be infected with HIV. We conclude th at many Thai obstetric providers are reluctant to care for HIV-infected wom en, do not routinely use perinatal ZDV prophylaxis, and prefer to terminate pregnancies among HIV-infected patients. Physician education concerning th e value of HIV screening and antiretroviral therapy in HIV-infected pregnan t women is needed urgently in Thailand.