The Role of the Obstetrician-Gynecologist in AIDS Prevention: The American Experience
The obstetrician-gynecologist is uniquely positioned to have a significant role in HIV prevention, in two ways. First, as the primary and often the only health care system contact for women in the reproductive age group, the obstetrician-gynecologist sees these women in a variety of circumstances ranging from family planning, to preconceptional, to prenatal, post partum, routine annual examinations, and more. Each of these occasions provides the opportunity, most often in a conducive setting, to review the social, sexual, and other relevant history, and to offer education, counselling, and testing if appropriate. Second, and perhaps in many ways more exciting, we have the opportunity to significantly reduce the rate of vertical transmission, if we can counsel and identify pregnant women and treat them with AZT as demonstrated in the 076 study. In the first instance, it is extremely difficult to measure the impact of our efforts on the behavior of patients and specifically to assign credit for any reduction in the number of new infections. In contrast, in the case of perinatal transmission, the demonstration of positive results was so dramatic as to cause the monitors of the AIDS Clinical Trials Group 076 study to abandon the controlled trial in February of 1994 and recommend AZT use for this purpose. The perinatal transmission rate in this study, conducted primarily in the United States (and one site in France), was reduced from 25.5% to 8.3%. [1,2] Although it is not likely to continue, the results with this approach in our own institution are even more striking, with only one infected neonate in the last forty born to HIV-infected mothers who received AZT according to the protocol.
KeywordsRisk Behavior Civil Liberty Post Partum American Experience Perinatal Transmission
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- 4.New York State Department of Health — AIDS Institute. “Clinicians guide to HIV prevention and post-test counselling,” 1995.Google Scholar