The substantial decrease in perinatal HIV infection in the United States since 1992 represents a significant public health success. However, perinatal transmission of HIV continues to occur in the United States.

Infant infections can be associated with interruptions at any stage of care for HIV-infected women, from pre-conception care through follow-up for exposed infants.

Increasing Infections among Women
Lack of Prenatal Care
HIV Infection During Pregnancy
Barriers to HIV Testing
Barriers to Antiretroviral Use
Lack of Nationally Representative Data

Increasing Infections among Women

• Infections among women accounted for less than 10% of reported new AIDS cases in 1985 but over one quarter of reported new cases in 2005 (10).

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Lack of Prenatal Care

• Lack of prenatal care for HIV-infected women contributes to ongoing perinatal transmission (40).
• 12% of HIV-infected women giving birth between 1999 and 2001 in 24 Enhanced Perinatal Surveillance sites received no prenatal care (15).

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HIV Infection During Pregnancy

• Pregnant women may have increased susceptibility to HIV infection (32), and maternal infection during pregnancy may account for a substantial fraction of remaining perinatal transmissions (58).

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Barriers to HIV Testing

• Between 2001 and 2004, 7% of mothers of HIV-exposed infants and 32% of mothers of HIV-infected infants reported to HARS were not recognized as HIV-infected prior to delivery (12).
• Barriers to routine prenatal testing may be posed by requirements for lengthy HIV prevention counseling and written documentation of informed consent for HIV testing (48).
• Testing rates are often higher in areas employing either “opt-out” or mandatory newborn testing strategies as compared to “opt-in” strategies, which require specific written documentation of informed consent for HIV testing (18).

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Barriers to Antiretroviral Use

• Many HIV-infected women and their infants still do not receive appropriate antiretroviral treatment and prophylaxis.
• Between 2001 and 2004,
• 46% of HIV-infected infants reported to HARS had not received prenatal ZDV
• 41% had not received ZDV during labor and delivery
• 25% had not received postnatal ZDV (12).
• Many of these infections could have been prevented had women’s HIV infection been identified through adequate preconception and prenatal care and had they received appropriate prophylactic interventions.

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Lack of Nationally Representative Data

• The current HIV case surveillance system is heterogeneous across states and territories, and data for decision making are incomplete.
• As of February 2007, 53 health departments (states and other affiliated jurisdictions) employed a confidential name-based HIV reporting system, while 3 others used code-based systems.
• HIV surveillance conducted using coded patient identifiers has not been shown to routinely produce equally accurate, timely or complete data to that conducted using confidential name-based surveillance methods.
• CDC recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infections (14).

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