U.S. Public Health Service Recommendations for Human Immunodeficiency Virus Counseling and Voluntary Testing for Pregnant Women

07-28-95 12:25PM FROM DHHS-OASH/OC TO 916199424979 P010/010
2 MMWR July 7, 1995
The U.S. Public Health Service (PHS) encourages all women to adopt behaviors
that can prevent HIV infection and to learn their HIV status through counseling and
Voluntary testing. Ideally, women sbuuld know their HIV infection status before becoming pregnant. Thus, sites serving women of childbearing age (e.g., physicians'
offices, family planning clinics, sexually transmitted disease clinics, and adolescent clinics) should counsel and offer voluntary HIV testing to women, including
adolescents-regardless of whether they are pregnant. Because specific services
must be offered to HIV-infoctcd pregnant women to prevent perinatal transmission,
PHS is recommending routine HIV counseling and voluntary testing of all pregnant
women so that interventions to improve the woman's health and the health of her
infant can be offered in a timely aid effective manner.
The recommendations in this report were developed by PHS as guidance for
health-core providers in their efforts to a) encourage HIV-infected pregnant women
to learn their infection status; b? advise infected pregnant women of methods for
preventing perinatel, sexual, and other modes of HIV transmission; c facilitate appropriate follow-up for HIV-infected women, their infants, and their families: and d) help
uninfected pregnant women reduce their risk for acquiring HIV infection. Increased
availability of HIV counseling, voluntary testing, and follow-up medical and support
services is essential to ensure successful implementation of these recommendationo.
These services can be optimallydelivered through a reidily available medical system
with support services designed to facilitate ongoing care for patients.
BACKGROUND
HIV Infection and AIDS in Women and Children
HIV infection is a major cause of illness and death among women and children.
Nationally, HIV infection was the fourth leading cause of death in 1993 among women
25-44 years of age (2) and the seventh leading cause of death in 1992 among children
1-4 years of age (3). Blacks and Hispanics have been disproportionately affected by
the HIV epidemic. In 1993, HIV infection was the leading cause of death among black
women 2544 years of age and the third leading cause of death among Hispanic
women in this age group (2). In 1991, HIV infection was the second leading cause of
death among black children 1-4 years of age in New Jersey, Massachusetts, New York,
and Florida and among Hispanic children in this age group in New York (CDC, unpublished date).
By 1995, CDC had received reports of >58,000 AIDS cases among adult and adolescent women and >5,500 cases among children who acquired HIV infection perinstally.
Approxlmately one half of alr*AtlScases* aronrg Women have been attributed to
injecting-drug use and one third to heterosexual contact. Nearly 90% of cumulative
AIDS cases reported among children and virtually all new HIV infections among children in the United States can be attributed to perinatal transmission of HIV. An
increasing proportion of perinatally acquired AIDS cases has been reported among
children whose mothers acquired HIV infection through heterosexual contact with an
infected partner whose infection status and risk factors were not known by the mother.
Data from the National Survey of Childbearing Women indicate that in 1992, the
estimated national prevalence of 1-IV infection among childbearing women was

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