An early assessment of the social circumstances of a newly diagnosed HIV-positive woman is important. Patients who initially refuse interventions or default from follow-up need to be identified and actively followed-up. Support by trained peer-support workers is a valuable component of the management of HIV-positive pregnant women. Many newly diagnosed HIV-positive pregnant women are initially PLX4032 solubility dmso reluctant to engage with peer support; however, the great majority of women who do engage with it find that it becomes one of the most highly valued of all the interventions that they undertake [314]. The importance of informing appropriate healthcare

workers should be emphasized. This includes midwives, general practitioners, health visitors and paediatricians. The process of in-patient care should be explained clearly, so that the women can be helped to inform ward staff explicitly about levels of disclosure to visitors. Depending on the setting, levels of disclosure of newly diagnosed pregnant women about their HIV

status vary, and there are cultural factors that influence the patterns of self-disclosure to partners and other social network members [313],[315]. Disclosure should be encouraged in all cases but may be viewed as a process that may take some time [316, 317]. There are GSK458 ic50 situations where a newly diagnosed HIV-positive woman refuses to disclose to a current sexual partner, or appears to want to delay disclosure indefinitely. This can give rise to very complex professional, ethical, moral and, potentially, legal situations. There is a conflict between the duty of confidentiality to the index patient and a duty to prevent Fenbendazole harm to others. Breaking confidentiality to inform a sexual partner of the index patient’s positive HIV status is sanctioned as a ‘last resort’ by the WHO [318] and General Medical Council [319]. However, it is not to be taken lightly as it could have the negative impact of deterring others from testing because of the fear of forced disclosure and loss of trust by patients in the confidential doctor–patient relationship.

Difficult disclosure cases should be managed by the MDT. It is important to accurately record discussions and disclosure strategy in difficult cases. Simultaneous partner testing during the original antenatal HIV test should be encouraged wherever possible, as couples will frequently choose to receive their HIV test results together, providing simultaneous disclosure. Reassurance about confidentiality is extremely important, especially regarding family members and friends who may not know the diagnosis but are intimately involved with the pregnancy. Women from communities with high levels of HIV awareness may be concerned about HIV ‘disclosure-by-association’ when discussing certain interventions, including taking medication during pregnancy, having a CS, and avoiding breastfeeding.