HIV Among Pregnant Women, Infants and Children in the United States
March 23, 2016
Perinatal HIV, also known as mother-to-child transmission, can happen at any time during pregnancy, labor, delivery, and breastfeeding. CDC recommends that all women who are pregnant or planning to get pregnant take an HIV test as early as possible before and during every pregnancy. This is because the earlier HIV is diagnosed and treated, the more effective HIV medicines, called antiretroviral treatment (ART), will be at preventing transmission and improving the health outcomes of both mother and child.
Advances in HIV research, prevention, and treatment have made it possible for many women living with HIV to give birth without transmitting the virus to their babies. HIV infections through perinatal transmission have declined by more than 90% since the early 1990s, while the number of HIV-infected women giving birth has increased. Today, if a woman takes HIV medicines exactly as prescribed throughout pregnancy, labor, and delivery, and provides HIV medicines to her baby for 4-6 weeks, the risk of transmitting HIV can be 1% or less. In some cases, a Cesarean delivery can also prevent HIV transmission. After delivery, a mother can prevent transmitting HIV to her baby by not breastfeeding and not pre-chewing her baby's food.
Women who are HIV-negative but have an HIV-positive partner should talk to their doctor about taking HIV medicines daily, called pre-exposure prophylaxis (PrEP), to protect themselves while trying to get pregnant, and to protect themselves and their baby during pregnancy and while breastfeeding.
HIV and AIDS Diagnoses
- Approximately 8,500 women living with HIV give birth annually.
- Most (73%) of the estimated 174 children1 in the United States who were diagnosed with HIV in 2014 got HIV through perinatal transmission.
- Most (88%) of the estimated 104 children in the United States diagnosed with AIDS in 2014 got HIV through perinatal transmission.
Living With HIV
- Of the estimated 1,999 children living with perinatal HIV at the end of 2013, 1,298 (65%) were black/African American, 312 (16%) were Hispanic/Latino,2 and 212 (11%) were white.
- At the end of 2013, an estimated 9,131 adults and adolescents (aged 13 and older) were living with HIV acquired through perinatal transmission. Of these, 60% (5,495) were black/African American, 23% (2,093) were Hispanic/Latino, and 12% (1,118) were white.
- An estimated 4,998 children ever diagnosed with AIDS have died since the beginning of the epidemic through the end of 2013 (includes only those under age 13 at time of death).3 Almost all of them (91%) got HIV through perinatal transmission.
Rates (per 100,000 Live Births) of Perinatally Acquired HIV Infections by Year of Birth and Mother's Race/Ethnicity, 2008-2012
Note: Data include only persons born in the United States.
Source: CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data -- United States and 6 dependent areas -- 2013. HIV Supplemental Surveillance Report 2015;20(2).
- Pregnant women with HIV may not know they are infected. CDC recommends HIV testing for all women as part of routine prenatal care. According to CDC research, more women take the prenatal HIV test if the opt-out approach is used. Opt-out prenatal HIV testing means that a pregnant woman is told she will be given an HIV test as part of routine prenatal care unless she opts out and chooses not to have the test. In some parts of the country where HIV among women is more common, CDC recommends a second test during the third trimester of pregnancy.
- Many HIV medical care providers don't routinely offer pregnancy tests, preconception care, family planning services, or prenatal care for women with HIV. A woman with HIV may not know she is pregnant, how to prevent or safely plan a pregnancy, or what she can do to reduce her risk of transmitting HIV to her baby if she is pregnant.
- Women living with HIV can learn what to do to lower their risk of transmitting HIV to their babies. Women can:
- Take HIV medicines (antiretroviral treatment, or ART) for their own health if they think they might want to become pregnant.
- When pregnant, take HIV medicines the right way every day throughout the pregnancy, labor, and delivery.
- After delivery, ensure their infants take HIV medicines.
- Avoid breastfeeding.
- Avoid pre-chewing food for an infant, toddler, or anyone else.
- The risk of perinatal HIV transmission is much higher if the mother's antiretroviral HIV treatment is interrupted at any time during pregnancy, labor, or delivery, or if HIV medicines are not provided to her infant. Pregnant women living with HIV may have nausea during pregnancy that can interfere with taking medicines, and new mothers may not be able to see their HIV medical care provider consistently.
- Social and economic factors, especially poverty, affect access to all health care, and disproportionately affect people living with HIV. Pregnant women living with HIV may face more barriers to accessing medical care if they also use injection drugs, abuse other substances, or are homeless, incarcerated, mentally ill, or uninsured.
What CDC Is Doing
- CDC has developed a framework to guide federal agencies and other organizations in their efforts to reduce the rate of perinatal transmission of HIV to less than 1% among infants born to women with HIV and less than 1 perinatal transmission per 100,000 live births.
- CDC works with the François-Xavier Bagnoud Center (FXBC) to lead the Elimination of Mother-to-Child HIV Transmission Stakeholders Group. This group comprises more than 50 experts on maternal and child health, HIV and AIDS, policy, research, and surveillance. The Stakeholders Group is made up of six working groups that develop action plans and distribute information through the broader networks of their members, all working together to realize the goal of eliminating perinatal transmission.
- CDC and FXBC also lead the Expert Panel on Preconception Care and Reproductive Health for Persons Living with HIV. Its goal is to develop best practices and operational guidance for providing family planning, reproductive health, and preconception care services for people living with HIV.
- CDC partnered with the American College of Obstetricians and Gynecologists, CityMatCH, the Pediatric AIDS Chicago Prevention Initiative, and the National Fetal and Infant Mortality Review Program to develop a model to help local health systems identify and address missed prevention and treatment opportunities for pregnant women living with HIV. CDC also funds the Fetal and Infant Mortality Review (FIMR)/HIV Prevention Methodology National Resource Center, which provides information and technical support to communities using, or interested in using, the methodology.
- CDC offers information about perinatal HIV testing, counseling, and treatment to obstetricians, gynecologists, nurse-midwives, and other health care professionals through the One Test. Two Lives. campaign.
- CDC funds perinatal HIV prevention through Comprehensive HIV Prevention Programs for Health Departments. Key partner activities include promoting HIV testing and antiretroviral treatment for pregnant women and implementing the FIMR-HIV methodology.
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