Opt-out prenatal HIV testing in Newfoundland and Labrador

We read with interest the conclusions of a recent research letter by Ari Bitnun and coauthors1 and the supporting commentary by Kathleen Steel O'Connor and Susan MacDonald.2 Although we concur with the recommendation for prenatal HIV screening on an opt-out basis, both articles seem to imply that this is not being offered in Canada. In fact, Newfoundland and Labrador was the first province in the country to recommend routine prenatal HIV testing in 1992 and also to introduce it on an opt-out basis in 1997.

Based on a province-wide anonymous prenatal HIV prevalence study,3 in 1992 the Department of Health recommended that HIV testing be considered as part of routine prenatal care. During 1993, it was estimated that nearly half of pregnant women in the province underwent HIV testing, rising subsequently to two-thirds. A second prevalence study in 1996 indicated that HIV testing done on a voluntary basis might not include all those at risk for HIV. Consequently, in 1997 HIV testing was introduced across the province on an opt-out basis (long before such a recommendation was made by the US Institute of Medicine4). Currently, 94% of pregnant women are being screened for HIV status (internal data).

Since 1992, our prenatal screening program has identified a few HIV-positive pregnant women, with no cases of vertically transmitted HIV infection in children born after 1994. However, our province has a low HIV prevalence; therefore, prenatal screening on an opt-out basis may be more effective and beneficial in populations with a higher prevalence.

Christa L. Mossman Department of Family Medicine Memorial University of Newfoundland St. John's, Nfld. Samuel Ratnam Newfoundland Public Health Laboratory St. John's, Nfld.