Maryland: Expectant Mothers Urged to Get Tested for AIDS

On Monday in Baltimore, city Health Commissioner Dr. Peter Beilenson and others said HIV testing should be routine for pregnant women. State law requires syphilis testing, but not HIV testing, for pregnant women.

Beilenson said the test should be offered on an opt-out basis, wherein the pregnant patient is tested unless she requests not to be. "When it's been offered opt-out, it's been almost universally accepted," he said.

Dr. Lindsay Alger, medical director for labor and delivery at the University of Maryland Medical Center, said studies have found that opt-in testing, in which women request to be tested, fails to find more than 40 percent of AIDS cases. Some women are discouraged from testing because, "by having to say yes, it made it look like you were engaged in high-risk behavior," Alger said.

Ninety-one percent of AIDS cases among children, Beilenson said, are attributable to mother-to-child transmission; some 17,000 such cases have been recorded in the United States since the epidemic's beginnings. Prior to the advent of antiviral treatment, HIV-infected mothers transmitted the virus to their newborns about one-quarter of the time. Drug therapy has pushed the transmission rate below 1 percent for women who take the medications early and consistently. But treatment can be effective even if started as late as the time of labor, noted Jan Kriegs, director of the midwife service at the medical center. Only two Baltimore babies were born HIV-infected in 2003, compared to 14 in 1994, Beilenson said.

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