A report, published in the Royal Society of Medicine Journal, says low uptake of HIV testing in pregnancy in the UK has created a largely avoidable "legacy" of infected children.

The report examines the policies of 15 European Community countries, many of whom make sure such a test is offered to all pregnant women.

But parts of the UK which simply offer the test have found that uptake is so low as to render the programme "scarcely worthwhile".

It adds: "This leaves an inevitable legacy of HIV-infected children which could largely have been avoided."

Babies can be protected

If HIV is discovered before birth, treatments and precautions can not only protect doctors and other health workers, but also greatly reduce the chances of the disease being transmitted from mother to child.

However, the question of mandatory testing - or even the routine offering of the test - opens a moral and ethical minefield for doctors.

Women who test positive, or refuse testing, could find themselves unable to get health insurance, and their right of confidentiality could be compromised by doctors who know that a partner is at risk of infection.

The team of antenatal and HIV specialists behind the report asked: "Does a pregnant woman have the right not to know her HIV status, when the information is relevant to the health of her unborn child?"

Blood samples are already taken

Blood samples, said the report, are routinely taken during pregnancy, so the addition of the HIV detection test would be easy.

The report said: "If we wish to achieve a substantial reduction in HIV transmission from mother to child, a fundamental requirement is to know the status of the mother in time for appropriate interventions."

It concludes that only society can resolve the ethical issues and calls for a debate.

If HIV is detected in a pregnant woman, modern anti-retroviral treatments, delivery by caesarian section to avoid blood to blood contact between mother and child, and the future avoidance of breastfeeding act to largely remove the risk of transmitting the disease.