Objective: To determine the uptake and acceptability of different methods of a universal offer of voluntary HIV testing to pregnant women. Design: Randomised controlled trial involving four combinations of written and verbal communication, followed by the direct offer of a test. The control group received no information and no direct offer of a test, although testing was available on request. Setting: Hospital antenatal clinic covering most of the population of the city of Edinburgh. Subjects: 3024 pregnant women booking at the clinic over a 10 month period. Main outcome measures: Uptake of HIV testing and women's knowledge, satisfaction, and anxiety. Results: Uptake rates were 6% for those in the control group and 35% for those directly offered the test. Neither the style of leaflet nor the length of discussion had an effect on uptake. Significant independent predictors of uptake were a direct test offer; the midwife seen; and being unmarried, previously tested, and younger age. Knowledge of the specific benefits of testing increased with the amount of information given, but neither satisfaction nor anxiety was affected by the type of offer. Conclusions:The universal offer of HIV testing is not intrusive and is acceptable to pregnant women. A policy of offering the HIV test to all women resulted in higher uptake and did not increase anxiety or dissatisfaction. Uptake depends more on the midwife than the method of offering the test. Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing.

Before any new antenatal screening test is introduced, the opinions of pregnant women should be considered. This is particularly relevant with HIV testing. This qualitative study reports the views of 29 women attending an antenatal clinic in a large maternity hospital in Scotland where a trial of different ways of offering HIV testing on a universal, voluntary basis occurred. Women were in favour of a test offer, although they did not necessarily wish to accept testing for themselves. Generally they were more worried about having an unhealthy baby. There was a commonly held view that routine testing would cause less anxiety because it would eliminate the stigma of saying yes to testing. A move towards the HIV test being recommended to pregnant women as opposed to merely offered is likely to be acceptable, would probably increase uptake rates and should therefore be assessed.

As part of a trial on the uptake of antenatal HIV testing, this study investigated the effect of the midwife on women's uptake of testing. Ten midwives who had been involved in offering HIV testing to 2727 women antenatally completed a questionnaire examining their knowledge and attitudes towards HIV. The midwife with the most positive attitude towards HIV testing was the one who achieved highest uptake and caused women least anxiety. Midwives' knowledge was not associated with uptake of HIV testing. If high uptake of testing is the goal, then midwives must have a positive approach towards HIV testing. Recommendations for midwife training are represented.

The aim of this study was to compare the cognitions of pregnant women who decide to take a n H I V test with those who decide against testing. As part of a randomized controlled trial of different methods of offering the H I V test, 1,817 antenatal attenders who were offered a test completed a questionnaire following the consultation. The measures were based on constructs from social cognition models. Uptake was noted and 'testers' and 'non-testers' were compared, There were 642 testers (35%) and 11 75 non-testers (65%). The most frequently reported reasons for taking and not taking the H I V test were, respectively: 'It's a good idea to have it as a routine test' and 'I've been in a stable relationship for a long time'. Independent predictors of uptake were: being in favour of testing, the midwqe seen, being single, perceived benefits for the baby, perceived benefits for research, perceived risk of H I V and knowledge that breastfeeding can transmit HIE I n areas where an increase in uptake is desired, information given to women should focus on increasing perceived benefits of testing for the baby, perceived risk and knowledge about breastfeeding. Making the test more routine may increase women's positive attitudes towards the test, thereby increasing uptake.