Decades-Long Effort to Enact Universal HIV Screening for Pregnant Women in Israel
Dr. Hila Elinav burst into tears of joy when the Israeli Ministry of Health announced a sweeping new HIV screening policy for pregnant women in September.
“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 the doctor’s visit for all pregnant women in Israel, enabling detection of the virus in women who may have gone undiagnosed, and prevention of viral transmission to babies for those women discovered to be living with the virus. Previously, only women who were considered high-risk, such as women who engage in sex work, people 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,” explains 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 most countries adopted the World Health Organization’s universal HIV screening guidelines for pregnant women, Israel was among the exceptions. Instead in 2007, the Ministry of Health issued its high-risk testing guidelines. HIV testing was already free in Israel, so mandatory testing wasn’t viewed as necessary.
A coalition of medical and nonprofit organizations disagreed and worked tirelessly for more than a decade to try to change the guidelines. Idan Barak is Executive Director of the Israel AIDS Task Force, one of the nonprofit groups dedicated to this cause. “This has been one of our biggest challenges,” he says. “It was a relentless ping pong match, where year after year, we appealed to the ministry.”
Gilead has long partnered with community organizations to advance HIV prevention and treatment strategies, so in 2019 the company joined the ongoing efforts of the Israel AIDS Task Force, as well as the Israeli Society for HIV Medicine and Osheya, a women’s health organization. Together they helped deliver a coordinated campaign to policymakers with three main messages. They first appealed on moral grounds that it was inhumane for a baby to be born with HIV when a simple test could help prevent it. They also made the case that doctors could be held legally liable for babies born with HIV, and they presented data showing the cost effectiveness of early detection and treatment.
After years of ongoing dialogue with the Ministry of Health, the new guidelines were approved last fall. “Finally, we were heard. Working together toward one purpose and one strategy was a key reason the long-awaited change happened,” says Idan.
Under the new universal testing policy, detecting HIV early in a pregnancy means antiretroviral treatment can begin immediately, helping reduce the risk of transmission to the baby. Having such a testing program could also 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 seen the ripple effect the disease has on the family and society. He has counseled youngsters who have grown up living with HIV.
“In Israel the stigma is very, very strong,” he says. “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,” says Idan. “How many times can you say you had an impact on someone’s life?”
Image by Gulcin Guler
Photo of Idan Barak on LinkedIn by Nir Sasson