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U.S. Public Health Service Recommendations for HIV Counseling and Voluntary Testing for
Pregnant Women
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These recommendations were developed by the U.S. Public Health Service to address the increasing epidemic of human immunodeficiency virus (HIV) infection among women and their infants.
The recommendations stress the importance of early diagnosis of HIV infection for the health of both women and their infants and are based on advances made in HIV-related treatment and prevention.
The most significant advance for this population has been the results from a placebo-controlled, clinical trial that indicated that administration of zidovudine to HIV-infected pregnant women and their newborns reduced the risk for perinatal transmission of HIV by approximately two thirds.
Routine HIV counseling and voluntary testing is recommended for all pregnant women and is intended to serve as guidance for health-care providers in educating women about the importance of knowing their HIV infection status. For uninfected women, such HIV counseling and testing programs can provide information that can reduce their risk for acquiring HIV; for women who have HIV infection, these programs can enable them to receive appropriate and timely medical interventions for their own health and for reducing the risk for perinatal (i.e., mother to infant) and other modes of HIV transmission. These programs also can facilitate appropriate follow-up care and services for HIV-infected women, their infants, and other family members.
During the past decade, human immunodeficiency virus (HIV) infection has become a leading cause of morbidity and mortality among women, the population accounting for the most rapid increase in cases of acquired immunodeficiency syndrome (AIDS) in recent years. As the incidence of HIV infection has increased among women of childbearing age, increasing numbers of children have become infected through perinatal (i.e., mother to infant) transmission; thus, HIV infection has also become a leading cause of death for young children. To reverse these trends, HIV education and services for prevention and health care must be made available to all women.
Women who have HIV infection or who are at risk for infection need access to current information regarding:
Results from a randomized, placebo-controlled clinical trial have indicated that the risk for perinatal HIV transmission can be substantially reduced by administration of zidovudine (ZDV [also referred to as AZT]) to HIV-infected pregnant women and their newborns. To optimally benefit from this therapy, HIV-infection must be diagnosed in these women before or during early pregnancy.
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 should 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-infected 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 and effective manner.
The recommendations in this report were developed by PHS as guidance for health-care providers in their efforts to:
a) early interventions to improve survival rates and quality of life for HIV-infected persons,
b) strategies to reduce the risk for perinatal HIV transmission,
c) management of HIV-infection in pregnant women and perinatally exposed or infected children.
a) encourage HIV-infected pregnant women to learn their infection status;
These services can be optimally delivered through a readily available medical system with support services designed to facilitate ongoing care for patients.
b) advise infected pregnant women of methods for preventing perinatal, sexual, and other modes of HIV transmission;
c) facilitate appropriate follow-up for HIV-infected women, their infants, and their families;
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 recommendations.
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