Optimize patients' psychosocial situation to improve health behaviors in women infected with HIV: preventing vertical transmission.(Obstetrics)

SAN FRANCISCO -- The most important goal of prenatal care in HIV-positive women is to optimize the woman's health and her psychosocial situation, Dr. Deborah Cohen said at a meeting on HIV management sponsored by the University of California, San Francisco.

Preventing vertical transmission of the virus is important, but unless the clinician can reach the woman and let her appreciate that she is the patient and the focus of care, it will be difficult to attain any other goals, said Dr. Cohan of San Francisco General Hospital.

Focusing on the woman sets into motion an effective therapeutic relationship of the sort that many pregnant women have never experienced. Once this therapeutic relationship is in place, the clinician can more easily influence the woman's health behavior.

Optimizing the woman's health takes several specific forms in HIV-positive women. The goal of antiretroviral therapy, for example, should be total viral suppression. And the physician should offer prophylaxis for opportunistic infections and vaccines as needed.

The combination of ...