* This fact sheet uses the term "perinatal transmission" to mean vertical transmission of the HIV virus from an infected woman to her infant during pregnancy, at the time of birth, or in the week after birth; and the term "postnatal transmission" to mean vertical HIV transmission within 1 year after childbirth.
- HIV transmission from mother to child during pregnancy, labor, and delivery or by breast-feeding has accounted for 91% of all AIDS cases reported among children in the United States.(1)
- Although a comprehensive surveillance system for counting the total number of perinatally transmitted cases of pediatric HIV infection is not yet in place, an estimate may be made that approximately 500-700 infants were infected with HIV by mother-to-child transmission in 1997. This compares to an estimate of 1,000 to 2,000 per year before 1994/1995.(1, 2, 3)
- As of September 30, 1997, perinatal transmission of HIV accounted for 7,310 (1%) of the total number of 626,334 cumulative AIDS cases in adults and children reported to CDC by state and territorial health departments.(5)
- Of the 665,357 cumulative cases of AIDS diagnosed in the U.S. through June of 1998, 7,512 (1.1%) represent infants and children who contracted their infection through mother-to-child transmission.(3)
- Of the estimated 271,245 persons living with AIDS in the U.S. in 1997, 3,555 (1.3%) are under 13 years old, and the majority of these children contracted AIDS from mother-to-child HIV transmission.
- Five states and/or territories accounted for 64% of all perinatally acquired AIDS cases diagnosed by September, 1997: New York (27%); Florida (17%), New Jersey (9%), California (6%), and Puerto Rico (5%).(5)
- Eighty-five percent of all the 7,310 pediatric AIDS cases identified as perinatally acquired by September, 1997 were diagnosed in metropolitan areas with a population of greater than 500,000 persons; 9% were diagnosed in metropolitan areas with populations of 50,000-500,000 persons; the remainder were from smaller cities/towns or rural.(5)
- Looking at perinatally transmitted HIV/AIDS infections from the point of view of looking backwards from all AIDS cases diagnosed in children, there were 385 new pediatric AIDS cases reported in the 12 month period from July 97 to June 98. Of this number, 90% (345) were reported to be perinatally transmitted. And of this total, 58% represented African American children, 23% were Hispanic, 11% were Caucasian, and 1% Asian/Pacific Island or American Indian/Alaskan native.(3)
- Of the cumulative number of 7,335 children with the diagnosis of perinatally acquired AIDS through the end of 1997, 4,478 (61%) were African-American, 1,725 (24%) were Hispanic, 1,061 (14%) were Caucasian, 56 (less than 1%) were either Asian/Pacific Islander or American Indian/Alaskan Native; and 16 were of unknown race/ethnicity. Their median age at diagnosis was 17 months, with 40% of cases diagnosed in children aged less than 1 year; 47%, in children aged 1 to 5 years; and 13%, in children aged greater than or equal to 6 years.(4, 5)
- Looking at the numbers of children with perinatally acquired AIDS from the years 1992 to 1996 by race/ethnicity shows that there were declines in all races; a 42% decline in the number of African-American children affected, a 43% decline in Hispanic children, and a 50% decline in numbers of infected Caucasian children.(2)
- The absolute numbers of infants perinatally exposed to HIV remain highest for African-American children. In 1997, there were 261 new cases of AIDS cases identified as having been perinatally acquired that were reported in African American children, a figure 4 times as high as the 59 cases of perinatally acquired AIDS reported in Caucasian children. Hispanic children reported with perinatally acquired AIDS numbered 104 in 1997, less than half of the number of the African-American children.(4)
- By the end of June 1998, of the 259 infants reported from the 31 states who report new cases of perinatally transmitted HIV infection, 73% were African American, 18% were Caucasian, 8% were Hispanic, and 1% were Asian/Pacific Island or American Indian/Alaska native.(3) [Note: since not all states report cases of HIV infection, these numbers and proportions do not accurately represent the total United States estimates of perinatally transmitted HIV infections]
- It was estimated in a 1998 report that 6,000-7,000 women with HIV infection in the United States give birth each year. Between 1992 and 1995, there was a 17% decline in the number of births to women with HIV infection.(2)
- Approximately 15% of the women with HIV infection giving birth each year do not receive prenatal care.(2)
- See also "Economic and Social Profile of HIV-infected Women" on the Fact sheet on Women with HIV.
- From the beginning of the epidemic through June 1998, the cumulative United States total of children with perinatally acquired deficiency had reached 7,512. The categories of exposure for these children's mothers have been the following: injection drug use, 40% (2,992); sex with injection drug user, 18% (1,374); sex with HIV-infected person, risk not specified, 14% (1,086); sex with bisexual male, 2% (164); receipt of blood transfusion, blood components, or tissue, 2% (155); sex with person with hemophilia, 0.4% (29); sex with transfusion recipient with HIV infection, 0.3% (24); and those mothers with HIV infection for whom a specific risk was not identified numbered 1,688 or 22% of the total.(3)
- See also "Transmission of HIV Infection" on the Fact sheet on Women with HIV.
- The recent decline in numbers of perinatally infected infants born in the United States demonstrates rapid implementation of new knowledge in perinatal HIV prevention as published in 1994 and later treatment guidelines for the pregnant woman with HIV infection. Specifically, in the case of children born from 1994 through 1996, the proportion of mothers with HIV infection who were prescribed prenatal ZDV increased from 24% to 64%.(1, 5)
- Estimates of the proportion of children born to women with HIV infection who are themselves infected with HIV vary, ranging from 14% to 33% in studies performed in the United States and Europe before the new knowledge about treatment was disseminated. More recent estimates of the transmission rate, reflecting the increasing use of protective treatment, range from 3% to 10%.(2)
- A recently published study of perinatal transmission in 4 states from 1993 to 1996 found:
- increases in the proportion of pregnant women with HIV infection who were diagnosed before the birth of their child (from 68% to 81%);
- dramatic increases in the proportion of women who are HIV positive that are offered ZDV (from 5% to 85% prenatally);
- lack of prenatal care was a critical obstacle to fully implementing the guidelines: 74% of the women not offered ZDV had either no or limited prenatal care.(1)
- Among women in a CDC 4-city study ("PACTS"), ZDV use increased following the publication of the 1994 PHS recommendations, and the rate of perinatal transmission dropped from 21% to 11%. (That is, the proportion of mothers who are HIV positive who transmitted their infection to their newborns declined from 21 per 100 HIV+ women giving birth to 11 per 100.) The PACTS study includes women from four cities -- New York City, Newark, Atlanta, and Baltimore.(1)
- In North Carolina, perinatal HIV transmission dropped from 2l% in 1993 to 6.2% in the first half of 1996.(1)
- Between 1992 and 1996, AIDS cases that were identified as perinatally acquired declined 43% in the United States, and in the year 1997, the trend continued with a 30% decline. Historically, the estimated number of children with perinatally acquired AIDS had increased each year from 1984 through 1992.(1)
- Without improvements in maternal diagnosis, followed by treatment according to the recommended guidelines during pregnancy and the perinatal period, it is estimated that there would be approximately 1,750 infants who are HIV positive born in the United States per year, rather than the 500-700 estimated now.(1, 3, 5)
- Even before antiretroviral treatment was recommended to pregnant women, two of three HIV-exposed infants escaped HIV infection. Of those infants who do become infected, approximately 30% to 50% are thought to acquire it in utero and 50% to 70% during the intrapartum and the breast-feeding period.
- Mechanisms of vertical transmission of HIV:
- Transplacentally during in utero development;
- During the intrapartum (labor and delivery) period; and
- In the postpartum period by breast-feeding from the milk of a woman who has HIV infection.
- Early vertical transmission has been defined as transmission that is detected within the first 48 hours of life; late transmission is defined as negative virologic evaluations during the first week, with evidence of HIV detection between 7 and 90 days of age.
- Approximately 30 to 60% of infants with HIV infection have detectable levels of virus in the blood (by RNA testing) within 48 hours of birth, indicating that these infections may have occurred during in utero development. Approximately 90% of the infants with HIV infection will demonstrate presence of viral markers within 12 to 30 days of infection, and almost 100% within 30 to 90 days of birth.
- Factors associated with vertical HIV transmission:
- Higher HIV RNA viral load in blood (The correlation between higher HIV RNA levels in plasma and increased risk of vertical transmission has been confirmed in recent studies, although an absolute threshold, below which HIV transmission is completely avoided, has not been found).
- Breast-feeding: approximately 0.5% risk of infection each month that the baby is breast-fed.
- Older maternal age: increasing risk for each five year increment over 25 years.
- Cigarette smoking during pregnancy.
- Premature rupture of membranes (over 4 hours).
- Other obstetric factors: (use of scalp electrodes; potential transmission by the infant's swallowing maternal secretions and/or blood). (The presence of virus in gastric aspirates immediately following delivery has been reported.)
- An increased incidence of HIV vertical transmission has been reported in prematurely born infants.
- Although viral load is generally correlated with the risk of transmission, women with undetectable viral loads have in fact given birth to infants with HIV infection, and other women with very high HIV RNA levels have given birth to uninfected infants.
- In a prospective study of 271 infants with HIV infection, 38% of children were found to be positive within 48 hours of life, 93% were positive by 14 days of age, and 96% of the total number of infected children were positive by four weeks of age. There are infants who might not have detectable virus as late as three months following delivery in selected cases. Infected infants will undergo a period of acute primary viremia similar to recently infected adults. The HIV virus burden is extremely high in the first months of life.
- Postpartum transmission of HIV by breastmilk may pose an excess risk of infection (beyond the risk that already exists in pregnancy and delivery) as high as 28%, with studies showing actual breast-feeding transmission rates between 5 to 12% in Africa. Ongoing studies of late post-natal transmission have indicated that many cases of transmission via breastmilk occur after four months of age.
- Mothers who seroconvert to a HIV+ status after delivery and while breast-feeding appear to have a higher risk of transmission than women who were previously infected.
- From the data currently available, use of antiretroviral therapy during pregnancy and the perinatal period is still the major protective factor in reduction of HIV vertical transmission prior to delivery.
- In 1994, the AIDS Clinical Trials Group (ACTG) Protocol 076 showed that women with HIV infection could significantly reduce the risk of transmitting the virus to their babies if they were given zidovudine (ZDV) during pregnancy, labor, and delivery, and if their babies were also given ZDV for their first 6 weeks. The United States Public Health Service then issued guidelines for using ZDV during pregnancy, followed in 1995 by further guidelines from CDC for routinely counseling all pregnant women about HIV and offering HIV testing. In 1997-1998, the guidelines for treatment of HIV women who are pregnant were updated.(9)
- The ACTG 076 regimen for pregnant women with HIV infection consisted of:
- ZDV (100 mg five times daily starting at week 26 of pregnancy and throughout the third trimester);
- intravenous ZDV (1mg/kg/hour) during delivery, and;
- oral treatment of the newborn infant (2 mg/kg every 6 hours) for the first 6 weeks of life.
This treatment cut the rate of maternal-infant HIV transmission by about 70%, from a 25.5% transmission rate in those mothers taking placebo, versus 8.3% in those randomized to receive ZDV.(7)
- Later studies have evaluated the relationship between decreased viral load as a result of ZDV treatment, and the likelihood of HIV transmission. While ZDV was associated with a decrease in HIV RNA levels, the reduction in transmission was only partly explained by the decrease in HIV RNA levels. It is for this reason that all pregnant women with HIV are advised to take ZDV during pregnancy, even if their own antiretroviral requirements do not include use of this drug.(7)
- A recent study has found that HIV-negative infants exposed to ZDV in utero, as treatment for the mother's HIV positive status, did not show any significant adverse effects from this medication as compared with a similar group of infants who received placebo. The follow-up continued for over four years.(10)
Treatment Guidelines and Reports
- Success in Implementing Public Health Service Guidelines to Reduce Perinatal Transmission of HIV - Louisiana, Michigan, New Jersey, and South Carolina, 1993, 1995, and 1996. MMWR, Vol. 47, No. 33, August 28, 1998.
- Public Health Service Task Force Recommendations for the Use of Antiretroviral Drugs in Pregnant Women Infected with HIV-1 for Maternal Health and for Reducing Perinatal HIV-1 Transmission in the United States. MMWR, Vol. 47 (No. RR-2), January 30, 1998.
- HHS Guidelines for the Use of Antiretroviral Agents in HIV Infected Adults and Adolescents, December 1, 1998: Table XVII. Preclinical and Clinical Data Relevant to Use of Antiretrovirals in Pregnancy; Table XVIII. Zidovudine Perinatal Transmission Prophylaxis Regimen.
- U.S. Public Health Recommendations for Human Immunodeficiency Virus Counseling and Voluntary Testing for Pregnant Women. Centers for Disease Control and Prevention (CDC). July 7, 1995/Vol.44/No. RR-7.
- Revised guidelines for prophylaxis against PCP for children infected with or perinatally exposed to HIV. Centers for Disease Control and Prevention, MMWR: July 7, 1995/Vol.44/No. RR-4.
Prevention Issues in Addition to ZDV Treatment
- Highlights from the 1998 report from the Institute of Medicine, "Reducing the Odds: Preventing Perinatal Transmission of HIV in the U. S."(2)
- HIV testing should become a routine part of prenatal care; health care providers should notify women that HIV testing is part of the usual array of prenatal tests, and women should have an opportunity to refuse.
- Although states have made substantial progress in reducing perinatal HIV transmission, many pregnant women are still not tested and do not receive treatment. The new approach could both a) help reduce the number of pediatric AIDS cases and b) improve treatment for mothers with AIDS.
- Until HIV testing and treatment is standard for all pregnant women, the number of children born with HIV will remain unacceptably high.
- The goal of the recommended national policy of universal HIV testing, with patient notification, as a routine component of prenatal care is to ensure that "all pregnant women be tested for HIV as early in pregnancy as possible, and those who are positive remain in care so that they can receive optimal treatment for themselves and their children."
- Further reductions in perinatal HIV transmission in the United States will require that the following issues are addressed: 1) universal HIV testing of pregnant women as recommended in the 1998 Institute of Medicine Report, 2) reaching all women with early prenatal care.(11)
- Sites serving women of childbearing age should counsel and offer voluntary HIV testing to all women, including adolescents -- regardless of whether they are pregnant.(12)
- C-section Deliveries and HIV Vertical Transmission:
- A meta-analysis of 8,533 mother-infant pairs from 20 European and North American centers showed that in those women who were not taking antiretroviral agents during pregnancy, the transmission rate for those who underwent C-section was 10.4%, compared with a rate of 19% in those with vaginal delivery. In women who had received antiretrovirals during pregnancy, the rate of HIV transmission to the infant was 2% in women undergoing elective C-section, versus 7.3% in those who delivered vaginally. This study concluded that elective C-section was associated with a 43% decrease in HIV transmission rate, after adjusting for use of antiretroviral therapy, advanced maternal HIV disease, and low infant birth weight.(7)
- A small recent Swiss study reported no perinatal HIV transmission among mother-infant pairs who received a complete ZDV regimen and who underwent elective C-sections.(7)
- Another study did not show a beneficial effect of elective C-section in decreasing HIV vertical transmission rates in women who did not receive antiretroviral therapy.(7)
- A 1999 publication, released by the New England Journal of Medicine before its scheduled print date because of its public health importance, has shown that elective cesarean section reduces the risk of transmission of HIV-1 from mother to child independently of the effects of treatment with ZDV. The likelihood of vertical transmission of HIV-1 was decreased by 50% with elective cesarean section, as compared with other modes of delivery, and by 87% with both cesarean section and antiretroviral therapy during the prenatal, intrapartum, and neonatal periods. Among all the mothers who mothers who received recommended ZDV therapy, the rates of vertical transmission were 2.0% in those who underwent elective cesarean section, and 7.3% among those with other modes of delivery.(13)
- Since previous studies indicate that women with HIV infection living in less-developed countries have an increased risk of peripartum and postpartum infectious complications that are related to the level of immunologic deficiency, as well as an increased risk of postoperative complications, the potential risks associated with elective cesarean section would appear to outweigh the potential benefit in terms of decreased vertical transmission of HIV-1 in these situations.(13)
- If antiretroviral therapy has not been used during pregnancy or delivery, ZDV therapy should be offered to the infant, and begun as quickly as possible after birth, continuing for the first six weeks of life.(7)
- Although perinatally acquired AIDS cases in children have declined in all racial/ethnic groups in the United States, the majority of perinatally or vertically acquired AIDS cases continue to occur among African-American and Hispanic children. Intensified efforts are needed to prevent infection among minority women and to reach women who are infected with early prenatal care and preventive treatment.(3)
- In order to successfully prevent perinatal transmission of HIV/AIDS, current and accurate information on the numbers of HIV infections in infants is essential. The Centers for Disease Control and Prevention recommend that, as an extension of AIDS surveillance programs, all states and territories conduct surveillance for perinatal HIV exposure with follow-up to determine HIV-infection and AIDS status, and this recommendation is supported by the American Academy of Pediatrics.(5, 14)
- The Council of State and Territorial Epidemiologists (CSTE) has also recommended that all states conduct surveillance for pediatric HIV/AIDS and perinatal exposure. In 1995 this Council declared pediatric HIV infection a nationally notifiable disease.(5)
- Twelve states currently do not require either physician and/or lab reporting of pediatric HIV infection, based on the charted results of a mid-1997 survey of state epidemiologists.(15)
- CDC data suggest that at least 15% of women with HIV infection do not receive prenatal care, and over a third of women with HIV infection who use illicit drugs receive no prenatal care.(2)
- To maximize prevention efforts, women must be identified as having HIV infection as early as possible during pregnancy and offered effective antiretroviral therapy. Postnatal evaluation of the HIV at-risk infant, beginning immediately after birth, is important for early diagnosis and optimal medical management.(2)
- The ultimate prevention of mother-to-child HIV transmission is the prevention of HIV infection in women. Click here to go to the Fact sheet on Women and HIV.
- NIH: The Pediatric, Adolescent, and Maternal AIDS Branch - NIH (PAMA) Branch focuses on supporting and conducting research into the epidemiology, natural history, pathogenesis, transmission, and treatment of HIV infection and disease in infants, children, adolescents, pregnant women, mothers, women of childbearing age, and the family unit as a whole.
- "Finding New Treatments" - treatment and research information.
- "The ABC's of Research."
- National AIDS Treatment Advocacy Project.
- Centers for Disease Control and Prevention (CDC). (1998). Status of Perinatal HIV Prevention: U.S. Declines Continue: Hope for Extending Success to Developing World. Centers for Disease Control and Prevention. June, 1998.
- Institute of Medicine (IOM), National Academy Press. 1998. Reducing the Odds: Preventing Perinatal Transmission of HIV in the U.S.
- Centers for Disease Control and Prevention (CDC), National Center for HIV, STD and TB Prevention. (1998). HIV/AIDS Surveillance Reports, Mid-year 1998 Edition, Vol.10, No.1; Atlanta GA 30333; December 1998.
- Centers for Disease Control and Prevention (CDC), National Center for HIV, STD and TB Prevention (1998). HIV/AIDS Surveillance Reports, Year-end 1997 Edition. Vol. 9, No. 2. Atlanta GA 30333. December 1998.
- Centers for Disease Control and Prevention (CDC). (1997). Perinatally acquired HIV/AIDS. MMWR, 46:1086-92.
- Centers for Disease Control and Prevention (CDC). August 28, 1998. Success in Implementing Public Health Service Guidelines to Reduce Perinatal Transmission of HIV in Louisiana, Michigan, New Jersey, and South Carolina, 1993, 1995, and 1996. MMWR.
- "Pregnancy in the Setting of HIV Infection."
- "Pediatric HIV Infection." Nielson, Karen.
- Trends in the HIV and AIDS Epidemic, 1998 - National Center for HIV, STD, and TB Prevention.
- Lack of Long-Term Effects of In Utero Exposure to Zidovudine Among Uninfected Children Born to HIV-Infected Women. Culnane, Mary et al, Journal of the American Medical Association; 281;2,51, January 13 1999.
- State of Perinatal HIV Prevention in the United States: CDC Statement following the Institute of Medicine Report. Press Release October 14, 1998.
- MMWR, August 28, 1998.
- The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 -- A Meta-Analysis of 15 Prospective Cohort Studies. The International Perinatal HIV Group, New England Journal of Medicine, April 1, 1999.
- Surveillance of Pediatric HIV Infection, American Academy of Pediatrics, Committee on Pediatric AIDS. Pediatrics. February 1998, 101: 315-319.
- "Reporting Requirements of Diseases and Conditions Under National Surveillance" from the Council of State and Territorial Epidemiologists.
Noted by the CDC in the HIV/AIDS Surveillance Reports: Since HIV infection is not uniformly reported throughout the United States (not all states report HIV infection cases, unlike the reporting of AIDS cases), estimates of HIV infection in the population are currently limited and difficult.
- Success in Implementing Public Health Service Guidelines to Reduce Perinatal Transmission of HIV - Louisiana, Michigan, New Jersey, and South Carolina, 1993, 1995, and 1996. MMWR 47 (33), Aug 28, 1998.
- Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. MMWR 47 (RR-04) April 17, 1998.
- Update: HIV Counseling and Testing Using Rapid Tests + United States, 1995. MMWR 47 (11): 211-215, Mar 27 1998.
- Public Health Service Task Force Recommendations for the Use of Antiretroviral Drugs in Pregnant Women Infected with HIV-1 for Maternal Health and for Reducing Perinatal HIV-1 Transmission in the United States - MMWR 47 (RR-02), Jan 30 1998.
- Information About The Safety Of Combination Antiretroviral Treatment For Human Immunodeficiency Virus Infection During Pregnancy. Divisions of HIV/AIDS Prevention: HIV Information Page, October 20, 1998. National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention.
- JAMA 1998 Apr 8;279(14):1061-2 - From the Centers for Disease Control and Prevention. Administration of ZDV during late pregnancy and delivery to prevent perinatal HIV transmission -- Thailand, 1996-1998.
- Centers for Disease Control and Prevention. Public Health Service Task Force recommendations for the use of antiretroviral drugs in pregnant women infected with HIV-1 for maternal health and for reducing perinatal HIV-1 transmission in the United States. MMWR 1998; 47/RR-02.
- Mandelbrot L, Le Chenadec J, Berrebi A, et al. Decreased perinatal HIV-1 transmission following elective cesarean delivery with ZDV treatment [Abstract 23272]. 12th World AIDS Conference, Geneva, Switzerland, 1998.
- Read J, for the International Perinatal HIV Group. Mode of delivery and vertical transmission of HIV-1: a meta-analysis from fifteen prospective cohort studies [Abstract 23603]. 12th World AIDS Conference, Geneva, Switzerland, 1998.
- Taha T, Miotti P, Kumwenda N, et al. HIV infection due to breast-feeding in a cohort of babies not infected at enrollment [Abstract 23270]. 12th World AIDS Conference, Geneva, Switzerland, 1998.
- Kuhn L, Thea DM, Steketee RW et al. Preterm delivery and risks of intrauterine and intrapartum HIV transmission. 5th Conference on Retroviruses and Opportunistic Infections, Chicago, IL, February 1998:243 (Abs).
- Pitt J, and Cotton D. Treating the HIV-infected pregnant woman and her child. AIDS Clinical Care 9(12). December, 1997.
- CDC Recommendations of the U.S. Public Health Service Task Force on the use of ZDV to reduce perinatal transmission of human immunodeficiency virus. MMWR 1994;43(no. RR-11). [now updated]
- CDC National HIV/AIDS Hotline: 1 800 342-AIDS (-2437); for Spanish access call 1-800-344-7432; for TTY access, call 1-800-243-7889. Confidential information, referrals, and educational material on HIV/AIDS. Available 24 hours a day, 7 days a week.
- CDC National Prevention Information Network (NPIN) (formerly the National AIDS Clearinghouse), PO Box 6003, Rockville, MD 20849-6003; Phone 1 800 458-5231 or 1 301 519-0459.; from 9 to 6 M-F. Information, faxback, HIV/AIDS surveillance.
- The Antiretroviral Pregnancy Registry collects observational data on the use of antivirals by pregnant women. Providers may call 1-800-722-9292, extension 38465, to report data. Information is available by calling the same number.
Recent Quotes About Perinatal Transmission
"To boost prevention efforts, the federal government should establish a regional system of perinatal HIV prevention and treatment centers. These centers would help assure optimal HIV care for all pregnant women and newborns, and would help develop and implement strategies to improve HIV testing in prenatal care. Federal, state, and local public health agencies also should maintain appropriate surveillance data on HIV-infected women and children"
-- Institute of Medicine Report, 1998.
"By making HIV screening a routine part of prenatal care for all pregnant women, regardless of their risk factors or where they live, we can further lower the number of pediatric AIDS cases and help infected women get high-quality treatment."
-- Dr. Marie McCormick, Professor and Chair, Department of Maternal and Child Health, Harvard School of Public Health, Boston.
"We must recognize that enhanced testing by itself does not assure care for the woman with HIV infection. The prevention of HIV infection in women and children will only occur when there is support for truly inclusive interdisciplinary, culturally sensitive and appropriately supported programs that address all the underlying causes for preventing the spread of HIV infection."
-- From "Reducing the Odds: How to Reach the Unconverted?" by Dr. James Oleske, Francois-Xavier Bagnoud Professor of Pediatrics at New Jersey Medical School and Medical Director of the FXB Center.
Fact sheet compiled by Catherine Briggs, MD MPH
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