Antenatal HIV screening in regional Tasmania

Background: While Australia has a national recommendation for routine antenatal HIV testing of all pregnant women, the testing rates in Tasmanian remain low.

Objectives: This qualitative study used Foucauldian-informed discourse analysis to explore regional clinicians’ antenatal HIV testing practices and the perceived barriers to routine testing.

Methods: Twenty-three one-to-one semi-structured phone interviews were conducted with health and medical clinicians (Midwives n=10, General Practitioners (GP) n=9, and Obstetricians (n=4) from the north, northwest, and southern Tasmania.

Results: Antenatal HIV testing is practised within a discourse of clinical apathy; where the risk of HIV in pregnancy is perceived and talked about as a theoretical risk. The use of technical policy language such as ‘recommended’ acts to mitigate the fear of doing the wrong thing, i.e., deviating from the policy.

Conclusions: Overall, in regional Tasmania, antenatal HIV testing is undertaken within a hierarchy of technical terms and a historical discourse of HIV stigma. This appears is to constrain universal prenatal HIV testing of all women in Tasmania generating some confusion amongst clinicians as to who is eligible to be tested. Replacing the word ‘recommended’ with ‘universal’ in policy and guidelines may help to change practices.