Pregnant women in Donegal are missing out on routine HIV testing because of a dispute between the North Western Health Board (NWHB) and GPs in the county.
Representatives of the Irish Medical Organisation (IMO) and health board officials are to meet in Letterkenny next Monday to try to resolve the issue.
The situation in Co Donegal has been described as "unique" because ante-natal care is provided generally by GPs, unlike other areas where the woman has alternate hospital and GP appointments, and blood tests are done usually in the hospital. In Donegal, the woman's GP carries out the blood tests.
HIV tests have been offered to women attending ante-natal clinics in Sligo General Hospital since August. Screening has been introduced because new treatments have become available which greatly reduce the risk of infection passing to the baby if HIV is detected. Dr Charles Bourke, the IMO representative in Co Donegal, said the dispute had arisen because GPs felt they could not carry out the tests unless an adequate counselling service was put in place for women found to be HIV positive.
GPs are also unhappy with the payment the health board is offering them to carry out the test but say this is not the main issue.
"If a woman is picked up as being HIV positive, she will need a lot of counselling. We need assurances that ancillary services are going to be put in place," Dr Bourke said.
The IMO believes a recognised HIV counsellor should be assigned to the county so doctors could then refer patients when necessary.
"The meeting has been arranged quickly so we can get it sorted out. We felt we should have some input into what is needed to run the service properly, to ensure ancillary services are put in place, and we felt this wasn't being done," he said.
A statement from the NWHB said the HIV screening service was "being developed in Donegal where it is exclusively GP driven in order to make it more accessible" and that 50 per cent of GPs in the county had begun offering it.
However, Dr Bourke disputed this, saying a number of doctors had initially signed up, but some of these had withdrawn from the service since. He knew of only one doctor offering the test in the south of the county .
In its statement the health board also said "a full counselling service is in place at Sligo and Letterkenny General Hospitals".
The question of remuneration will be raised at Monday's meeting also. Dr Bourke explained that the national maternity contract agreed between the IMO and the Department of Health last May provided for nine free visits per pregnancy. HIV testing was not included and the IMO believed the test would require three additional visits. It has recommended a £17 payment but the NWHB is offering £12.
"We believe three visits would be required - the first to tell the woman about the test and to get her consent, the second to do the test, and the third to give the result," Dr Bourke said.
It was a very important test with major implications for the woman and her partner and it could cause a lot of stress, he said. Doctors would therefore need to spend a lot of time with each woman.