HIV screening in pregnancy
The College of Physicians and Surgeons of Manitoba, the Canadian Medical Association, and the Society of Obstetricians and Gynecologists of Canada have recommended that HIV screening be offered to all pregnant women regardless of risk. However, the extent of compliance with these recommendations is unknown and the experience of pregnant women is not well described. Using a variety of methodologies including feminist qualitative interviews, this dissertation examines the issue of prenatal HIV screening from a number of different perspectives. Physician compliance with the recommendations for prenatal HIV screening and their attitudes to this intervention are described. The experience of pregnant women offered screening is articulated through a qualitative analysis of their recollections. A chronological analysis of the policy process in the province is performed, as well as a cost-effectiveness analysis at two levels of seroprevalence. While physicians agree with the recommendations to offer screening to all pregnant women, the consistency with which they actually offer the test is variable. Pregnant women are also supportive of this intervention and will do whatever they can to ensure a healthy outcome of the pregnancy. The policy for screening in Manitoba is one of universal offering of the test with voluntary uptake and informed consent. Findings from this study support the present policy. Screening is cost-effective in both areas of high and low seroprevalence. Pregnant women, while appearing to have choices in their health care, in reality have limitations placed on their choices by lack of comprehensive information and a desire to be "good" patients. Health care providers, while striving to provide comprehensive care, are also limited by time constraints. Implications for practice, education, and research are suggested to address many of these issues.