Israel adopts universal screening of HIV for pregnant women
When the Israeli Ministry of Health announced a comprehensive new HIV screening policy for pregnant women in September, Dr. Hila Elinav burst into tears of joy.
“It was a long-awaited, emotional moment,” says Hila, a member of the Israeli Society for HIV Medicine and Director of the AIDS Center at Hadassah Medical Center in Jerusalem. “For 15 long years, HIV community advocates had been working on various fronts for this to happen.”
The new policy makes HIV screening a routine part of all pregnant women's doctor visits in Israel, allowing for the detection of the virus in women who may have gone undiagnosed and the prevention of viral transmission to babies for those women who are found to be infected. Previously, only high-risk women, such as those who engage in sex work, those who inject drugs, or those from an endemic country, were screened for HIV during pregnancy.
“Time is critical for treatment because a baby can be diagnosed during pregnancy,” explained Hila.
“If the woman starts treatment in the beginning, the chance of transmission is 0.3%, instead of 30%. Even if the woman is diagnosed in the third trimester, if the virus is undetectable at delivery, the chance of transmission is less than 1%.”
While the majority of countries followed the World Health Organization's universal HIV screening guidelines for pregnant women, Israel was an outlier. Instead, the Ministry of Health issued high-risk testing guidelines in 2007. Because HIV testing was already free in Israel, mandatory testing was not deemed necessary.
A coalition of medical and nonprofit organizations disagreed and worked for over a decade to change the guidelines. Idan Barak is the Executive Director of the Israel AIDS Task Force, a non-profit organisation dedicated to this cause.
“This has been one of our biggest challenges,” he said. “It was a relentless ping pong match, where year after year, we appealed to the ministry.”
Gilead has long collaborated with community organizations to advance HIV prevention and treatment strategies, so the company joined the Israel AIDS Task Force, as well as the Israeli Society for HIV Medicine and Osheya, a women's health organization, in 2019. They collaborated to deliver a coordinated campaign to policymakers with three key messages. They first argued that it was inhumane to have a baby born with HIV when a simple test could help prevent it. They also argued that doctors could be held legally liable for HIV-infected babies born, and they presented data demonstrating the cost effectiveness of early detection and treatment.
The new guidelines were approved last fall after years of ongoing consultation with the Ministry of Health. "At long last, we were heard. Working together toward a common goal and strategy was a key factor in bringing about the long-awaited change," said Idan.
Detecting HIV early in a pregnancy, under the new universal testing policy, means antiretroviral treatment can begin immediately, reducing the risk of transmission to the baby. A testing program like this could benefit the entire family.
“When you diagnose a woman, you are potentially diagnosing her partner too. In all, that’s three people you could be helping,” says Hila.
Idan has also witnessed the disease's repercussions on the family and society. He has counselled children who have grown up with HIV.
“In Israel the stigma is very, very strong,” he said. “Almost all the children I know who were born with HIV and are now teenagers are living with a secret because they are afraid of being isolated.” The coalition expects the policy change to lead to a reduction in the number of children born with HIV.
“It feels good to be part of a movement that directly helps so many people,” said Idan. “How many times can you say you had an impact on someone’s life?”
“It was a long-awaited, emotional moment,” says Hila, a member of the Israeli Society for HIV Medicine and Director of the AIDS Center at Hadassah Medical Center in Jerusalem. “For 15 long years, HIV community advocates had been working on various fronts for this to happen.”
The new policy makes HIV screening a routine part of all pregnant women's doctor visits in Israel, allowing for the detection of the virus in women who may have gone undiagnosed and the prevention of viral transmission to babies for those women who are found to be infected. Previously, only high-risk women, such as those who engage in sex work, those who inject drugs, or those from an endemic country, were screened for HIV during pregnancy.
“Time is critical for treatment because a baby can be diagnosed during pregnancy,” explained Hila.
“If the woman starts treatment in the beginning, the chance of transmission is 0.3%, instead of 30%. Even if the woman is diagnosed in the third trimester, if the virus is undetectable at delivery, the chance of transmission is less than 1%.”
While the majority of countries followed the World Health Organization's universal HIV screening guidelines for pregnant women, Israel was an outlier. Instead, the Ministry of Health issued high-risk testing guidelines in 2007. Because HIV testing was already free in Israel, mandatory testing was not deemed necessary.
A coalition of medical and nonprofit organizations disagreed and worked for over a decade to change the guidelines. Idan Barak is the Executive Director of the Israel AIDS Task Force, a non-profit organisation dedicated to this cause.
“This has been one of our biggest challenges,” he said. “It was a relentless ping pong match, where year after year, we appealed to the ministry.”
Gilead has long collaborated with community organizations to advance HIV prevention and treatment strategies, so the company joined the Israel AIDS Task Force, as well as the Israeli Society for HIV Medicine and Osheya, a women's health organization, in 2019. They collaborated to deliver a coordinated campaign to policymakers with three key messages. They first argued that it was inhumane to have a baby born with HIV when a simple test could help prevent it. They also argued that doctors could be held legally liable for HIV-infected babies born, and they presented data demonstrating the cost effectiveness of early detection and treatment.
The new guidelines were approved last fall after years of ongoing consultation with the Ministry of Health. "At long last, we were heard. Working together toward a common goal and strategy was a key factor in bringing about the long-awaited change," said Idan.
Detecting HIV early in a pregnancy, under the new universal testing policy, means antiretroviral treatment can begin immediately, reducing the risk of transmission to the baby. A testing program like this could benefit the entire family.
“When you diagnose a woman, you are potentially diagnosing her partner too. In all, that’s three people you could be helping,” says Hila.
Idan has also witnessed the disease's repercussions on the family and society. He has counselled children who have grown up with HIV.
“In Israel the stigma is very, very strong,” he said. “Almost all the children I know who were born with HIV and are now teenagers are living with a secret because they are afraid of being isolated.” The coalition expects the policy change to lead to a reduction in the number of children born with HIV.
“It feels good to be part of a movement that directly helps so many people,” said Idan. “How many times can you say you had an impact on someone’s life?”
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