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HIV among Pregnant Women, Infants, and Children in the United States
- All pregnant women should be screened for HIV as early as possible during each pregnancy.
- Women with HIV who take antiretroviral medication during pregnancy as recommended can reduce the risk of transmitting HIV to their babies to less than 1%.
- HIV disproportionately affects black/African American children in the United States.
HIV transmission from mother to child during pregnancy, labor and delivery, or breastfeeding is known as
perinatal transmission and is the most common route of HIV infection in children. When HIV is diagnosed before or during pregnancy, perinatal transmission can be reduced to less than 1% if appropriate medical treatment is given, the virus becomes undetectable, and breastfeeding is avoided. Since the mid-1990s, HIV testing and preventive interventions have resulted in more than a 90% decline in the number of children perinatally infected with HIV in the United States.
- In 2010, an estimated 217 children younger than the age of 13 years were diagnosed with HIV in the 46 states with long-term, confidential name-based HIV infection reporting since at least 2007; 162 (75%)1 of those children were perinatally infected.
- At the end of 2009, an estimated 10,834 persons who were diagnosed with HIV when they were younger than 13 years were living in the 46 states with long-term, confidential name-based HIV reporting. Of the total, 9,522 (88%) of these persons acquired HIV perinatally. Of these diagnoses of perinatal HIV infection, 63% were in blacks/African Americans, 22% were in Hispanics/Latinos,2 and 13% were in whites. These numbers include persons of all ages who were infected with HIV as children.
- The number of women with HIV giving birth in the United States increased approximately 30%, from 6,000–7,000 in 2000 to 8,700 in 2006.
- Despite the increase in the number of women with HIV giving birth, the estimated number of perinatal HIV infections per year in all 50 states and 5 US dependent areas continues to decline.
- Among perinatally infected children born during 2007 through 2009, black/African American children had the highest HIV rate per 100,000 live births each year, although the rate decreased from 15.2 in 2007 to 9.9 in 2009. The rates for Hispanic/Latino and white children remained stable during this time.
- From the beginning of the epidemic through 2009, an estimated 5,626 people who
were diagnosed with AIDS when they were younger than 13 years died in the 50
states and the District of Columbia. Of the total, 4,986 (89%) of them were
The reduction in perinatal HIV
infections in the United States
represents an important achievement in
public health. However, perinatal
transmission of HIV continues to
occur—and infant infections can be
associated with interruptions of care at
any stage of pregnancy for HIV-infected
women and their infants.
The following challenges can be
categorized as missed opportunities in
preventing perinatal HIV transmission:
- Enhanced primary HIV prevention
strategies for women and girls continue
to be needed and evaluated to prevent
new infections in these populations,
which will in turn, prevent perinatal
- Few HIV medical care providers
routinely provide preconception care or
family planning services to their
patients with HIV, which may result in
- Other missed opportunities for
perinatal HIV prevention include lack of
the following: appropriate prenatal
care, prenatal HIV testing (see bullet
below), prenatal antiretroviral
medication, Cesarean delivery for women
with a viral load greater than 1,000
copies/mL, and education on avoidance of
breastfeeding. Among the mothers of
HIV-infected infants reported to CDC
from 2003–2007, only 62% had at least
one prenatal visit, 27% were diagnosed
with HIV after delivery, and only 29%
received some antiretroviral medication
- HIV testing. Because approximately 18%
of all people with HIV do not know their
HIV status, many women who are infected
with HIV may not know they are infected.
The Centers for Disease Control and
Prevention (CDC) recommends routine,
opt-out3 HIV testing for all persons aged
13–64 years in health care settings,
including women during every pregnancy.
If women are tested and diagnosed with
HIV infection before or early in their
pregnancy, they can be given medication
to improve their own health and reduce
the risk of transmitting HIV to their
Other factors also pose prevention
- Substance abuse, mental illness, and
HIV-related stigma present barriers to
prenatal care in women living with HIV.
Increasing accessibility to prenatal
care services is crucial to sustain and
maximize the decline in perinatal HIV
- Socioeconomic issues associated with
poverty, including limited access to
high-quality health care, housing, and
HIV prevention education, may directly
or indirectly increase the risk factors
for HIV infection.
- Lack of awareness that pre-chewing of food for infants is a transmission risk.
- Of the more than 140,000 HIV-serodiscordant heterosexual couples (one partner is HIV-infected and the other is not) in the United States, about half of them want additional children; and many of these couples have
limited access to safe conception methods and services.
What CDC Is Doing
- CDC published Revised Recommendations
for HIV Testing of Adults, Adolescents,
and Pregnant Women in Health-Care
Settings in 2006. To further reduce the
number of children who are infected with
HIV perinatally, these recommendations
called for routine opt-out HIV testing
for all pregnant women, with repeat HIV
testing in the third trimester for women
who meet certain criteria.
- CDC, the Council of State and
Territorial Epidemiologists, and the
American Academy of Pediatrics have
recommended universal HIV perinatal
exposure reporting to ensure that
HIV-infected pregnant women receive all
necessary interventions to safeguard
their health and that of their infants.
- CDC has proposed a framework to
eliminate mother-to-child HIV
transmission (EMCT) in the United States
to guide efforts by federal agencies and
other national, state, and local
organizations. In this framework, EMCT
is defined as a transmission rate of
less than 1% among infants born to
HIV-infected women and less than 1
transmission per 100,000 live births.
- CDC is collaborating with the
François-Xavier Bagnoud Center (FXBC,
http://www.fxbcenter.org) to organize
and lead a group of stakeholders and
experts from maternal and child health,
HIV/AIDS, policy, research, and
surveillance fields to eliminate
mother-to-child HIV transmission in the
United States using the EMCT framework.
- CDC, the American College of
Obstetricians and Gynecologists,
CityMatCH, and the National Fetal and
Infant Mortality Review Program
developed a continuous quality
improvement methodology for local
systems to identify and address missed
prevention and treatment opportunities.
The Fetal and Infant Mortality Review (FIMR)/HIV
Prevention Methodology is underway in
nine sites, and an FIMR/HIV Prevention
Methodology National Resource Center
provides information and technical
assistance to any community interested
in conducting the methodology (www.fimrhiv.org).
- CDC has worked to educate
obstetricians, gynecologists, nurse
midwives, and other health care
professionals on the importance of
perinatal HIV testing and counseling
through the One Test. Two Lives.
campaign. CDC has also conducted
educational sessions for health care
professionals and sponsored a special
supplement titled “Achievements, Issues,
and Challenges: Prevention of
Mother-to-Child HIV Transmission in the
United States and in Resource-Limited
Settings” in the American Journal of
Obstetrics and Gynecology. For more
1The remaining 25% are categorized as “other,” which includes hemophilia, blood transfusion, and risk factor not reported or not identified.
2Hispanics/Latinos can be of any race.
3Opt-out HIV testing: Pregnant women are told that an HIV test will be included in the standard group of prenatal tests (that is, tests given to all pregnant women), and that they may decline the test. Unless they decline, they will receive an HIV test.