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Prevention/Epidemiology
Some Pregnant Women Still Go Untested for HIV Despite 1995 CDC Recommendations

July 29, 2003

More than 20% of pregnant women have never been tested for HIV, despite CDC recommendations released in 1995 calling for all pregnant women to be tested for the virus, the CDC announced yesterday at the 2003 National HIV Prevention Conference in Atlanta, Reuters Health reports. CDC researchers surveyed 346 pregnant women in 2001 and found that 24% had never been tested for HIV (Rauscher, Reuters Health, 7/28). A separate study found that more than 40% of women of childbearing age were unaware that treatment is available to help prevent mother-to-child HIV transmission (Sternberg, USA Today, 7/29). This statistic is based on the responses of 55,000 women between the ages of 18 and 44 who participated in the 2001 Behavioral Risk Factor Surveillance System, Reuters Health reports (Reuters Health, 7/28). According to the CDC, about 300 out of four million infants contract HIV from their mothers each year, compared with between 1,500 and 2,000 infants each year a decade ago (USA Today, 7/29). CDC Director Dr. Julie Gerberding said, "Each case of mother-to-child HIV transmission represents a failure of our public health system. Every pregnant woman should be screened for HIV so that treatment can be offered, if needed, to protect mother and child" (Gorner, Chicago Tribune, 7/29).

"Clear Signs"
CDC researcher Dr. Marc Bulterys said that some of the data presented at the conference indicate "clear signs of the progress we've made and the potential for still greater progress to come." One study conducted by Dr. Guthrie Birkhead of the New York State Department of Health found that HIV testing among pregnant women in the state has increased "sharply," from 64% in 1997 to 94% in 2002. The increase in testing rates paralleled a drop in the rate of vertical HIV transmission in the state -- 10.9% of HIV-positive pregnant women transmitted HIV to their infants in 1997, compared with 3.9% in 2001. Bulterys attributed New York's success to regulatory changes that ensure that women in labor and newborns are tested for HIV. In another study, conducted by Bulterys and members of the Mother Infant Rapid Intervention at Delivery (MIRIAD) group, the OraQuick rapid HIV test was able to deliver accurate results in a little more than one hour for women in labor whose HIV status was previously unknown. The group looked at 3,198 women who delivered in one of 14 hospitals in six U.S. cities. The "quick turn-around time" of the test allowed women in labor to receive antiretroviral treatment to prevent vertical HIV transmission if they tested HIV-positive, Bulterys said. In another study, Delmyra Turpin of the University of Illinois-Chicago examined information for 2,328 HIV-positive pregnant women enrolled in a major national study between 1990 and 2002 found that women were less likely to smoke or use alcohol or hard drugs during pregnancy between 1998 and 2002 "than at any other time during the study," Reuters Health reports. Bulterys said that all of the studies "demonstrat[e] the promise of efforts to reach pregnant women with HIV education and testing" (Reuters Health, 7/28).

Reaction
David Harvey, executive director of AIDS Alliance for Children, Youth & Families, said, "Education of health care providers remains the key to further reduction in HIV transmission from mother-to-child. Health care providers must offer an HIV test to every pregnant woman they see and recommend that she take it. There is no excuse for not offering an HIV test." He added, "These studies should not be interpreted to recommend changes in policy, but underscore the need to fully implement universal HIV counseling and voluntary testing." Harvey said, "Universal counseling and voluntary HIV testing works. CDC is wrong to suggest policies are failing or that we should move to more coercive HIV testing policies" (AIDS Alliance for Children, Youth & Families release, 7/28). The CDC in April announced a new HIV prevention strategy, which calls for HIV to be included in routine testing for pregnant women and urges local health authorities to make widespread use of a new rapid HIV test (Kaiser Daily HIV/AIDS Report, 7/28). Mark Isaac, vice president of the Elizabeth Glaser Pediatric AIDS Foundation, said that the study results "underscore[e] the tremendous need to make HIV testing and counseling a routine part of prenatal care. We've had tremendous success in the last decade in reducing mother-to-child transmission of HIV, but every new case represents a tragedy that could have been averted" (EGPAF release, 7/28).

Webcasts of selected sessions of the conference are available online through kaisernetwork.org's HealthCast.

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Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2003 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.




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