The chance that HIV infection will be transmitted from an HIV-infected pregnant woman to her child can be reduced to 2% or less (fewer than 2 out of every 100). This is possible because better medicines are available to treat HIV. But first, the pregnant woman and her doctor must know if she is infected with HIV.
- Many women across the United States do not get tested for HIV
- HIV-infected women who do not get tested often transmit HIV to
their infants. 2005 CDC data show that among HIV-infected infants
born in the 33 states which report HIV-exposed infants, 31% of the
mothers of HIV-infected infants had not been tested for HIV until
- Studies show that more women are tested when the HIV test is
included in the standard group of tests that all pregnant women
receive routinely, and when providers recommend HIV testing early in
pregnancy to all their pregnant patients.
- Since 1995, CDC has recommended all pregnant women be tested for
HIV and, if found to be infected, offered treatment for themselves
to improve their health and to prevent passing the virus to their
Approaches Are Available?
There are two different ways to approach pregnant women about HIV
- Pregnant women are given pre-HIV test counseling.
- They must agree to receiving an HIV test, usually in
- Pregnant women are told that an HIV test will be included in
the standard group of prenatal tests (that is to say, tests
given to all pregnant women), and that they may decline the
- Unless they decline, they will receive an HIV test.
Statistics published in the Nov.15, 2002, Morbidity Mortality
Weekly Report (MMWR) showed that in eight states using the opt-in
approach in 1998-1999, testing rates ranged from 25% to 69%. In
Tennessee, which uses an opt-out approach, the testing rate was 85%.
Other studies support this evidence that, of the voluntary approaches
to prenatal HIV testing, more women are tested with the opt-out
approach. An evaluation of opt-out testing in Birmingham, Ala.
prenatal clinic showed that HIV testing increased from 75% to 88%
after opt-out testing was implemented in August 1999. At the Denver
Health Medical Center, 98.2% of women who delivered received HIV
testing between 1998 and 2001, using opt-out testing.
For updated information about state laws in your area, please see the
Compendium of State HIV Testing Laws.
Does CDC Recommend?
In the 2006 Revised Recommendations for HIV Testing of Adults,
Adolescents, and Pregnant Womenin Health-Care Settings, CDC
recommended the opt-out approach to testing for all adult and adolescent
patients in health-care settings, including pregnant women.
- Universal “opt-out” HIV testing for all pregnant women early in
- A second test in the third trimester in certain geographic areas
or for women who are known to be at high risk of becoming infected
(e.g., injection-drug users and their sex partners, women who
exchange sex for money or drugs, women who are sex partners of
HIV-infected persons, and women who have had a new or more than one
sex partner during this pregnancy);
- Rapid HIV testing at labor and delivery for women without a
prenatal test result; and
- Exploration of reasons that women decline testing.
Studies show that the opt-out approach can:
- Increase testing rates among pregnant women; thereby, increasing
the number of pregnant women who know their HIV status;
- Increase the number of HIV-infected women who are offered
- Reduce HIV transmission to their babies.
Opt-Out Implemented in the Health Care Setting?
Opt-out has three steps for health-care providers to follow to put
this approach into practice (CDC recommends all three steps):
- Tell all pregnant women that an HIV test will be performed as part
of the standard group of tests for pregnant women.
- Tell all pregnant women that they may decline this test.
- Give all pregnant women information about how to prevent HIV
transmission during pregnancy and provide information about
treatment for pregnant women who are HIV-positive.
For more detailed information on the Revised
Recommendations for HIV Testing of Adults, Adolescents,
and Pregnant Women in Health-Care Settings, please refer to
Morbidity and Mortality Weekly Report (MMWR) of September 22, 2006,
or request a copy from the
National Prevention Information
Network at (800) 458-5231 or
For more information and free patient education materials, health
care providers are encouraged to visit the One
Test Two Lives website.