Two Mother-Baby HIV Cases Diagnosed in New Zealand – the First in Nearly 20 Years

New Zealand has seen its first cases of mother-to-child HIV transmission in nearly two decades, raising concerns about gaps in the country's healthcare system and antenatal screening processes.

Two babies in New Zealand were diagnosed with HIV last year, marking the first cases of perinatal transmission since 2007. This development has shocked public health officials, as the country had effectively eliminated mother-to-child HIV transmission through routine antenatal screening and preventive treatments.

According to the University of Otago HIV Epidemiology Group, the two children were born in 2023 to mothers who were not known to have HIV before or during their pregnancies. The cases have sparked a critical review of the healthcare system, with experts pointing to inconsistencies in antenatal care as a possible cause.

Jane Bruning, national co-ordinator of Positive Women Aotearoa, highlighted that the mothers were likely from countries with high HIV rates and may have missed their first-trimester screening. She emphasized that healthcare providers should have been more vigilant in identifying these risks.

"It’s quite negligent that this has happened," Bruning said. "There were lots of red lights there for people to have done the HIV test. I’m sure the people involved in the babies’ care are feeling terrible, but it’s not okay."

Dr. Sue McAllister, who leads the HIV Epidemiology Group at the University of Otago, acknowledged that while the 2006 introduction of HIV screening at the first antenatal visit significantly reduced mother-to-child transmission, the recent cases suggest that the system is not foolproof. She said the cases are a reminder that the healthcare system must ensure consistent access to antenatal care for all pregnant women, regardless of their background.

"It is not the woman, it is the system," McAllister said. "It is making sure that midwifery and antenatal care is available for everyone irrespective of where they live and who they are. And also ensuring the midwives know that HIV is still here."

The lack of national guidelines for antenatal screening has also been a point of concern. Some regions require patients to opt in for HIV testing, while others use an opt-out approach. Studies have shown that the opt-in method leads to lower screening rates, as it places the onus on healthcare providers to proactively offer the test.

In 2022, Auckland and Northland switched to an opt-out model, and the rate of patients getting tested increased from 86% to 98%. However, in other regions, the process is still not standardized, and some doctors use a blood test form that requires an extra tick for HIV screening, which can be easily missed.

Despite the recent cases, overall HIV prevention in New Zealand remains strong. Last year, 95 new HIV cases were diagnosed, down from an average of 140 per year before the pandemic. This decline is attributed to improved prevention strategies, including free pre-exposure medication, rapid testing, and the U = U (Undetectable = Untransmittable) campaign, which has helped reduce stigma and improve outcomes.

Deborah Woodley, director of Health NZ Te Whatu Ora’s Starting Well department, called the cases "concerning" but emphasized that the healthcare system is continuously evolving to better serve all communities.

"While no specifics of these cases can be provided to protect privacy, HIV notifications will continue to be monitored to understand any underlying issues or areas for improvement," she said.