The chance that HIV infection is transmitted from a mother who is HIV infected to her child during pregnancy can be reduced to 2 percent or less (fewer than 2 out of every 100). This is possible because of better medicines available to treat HIV. But first, the pregnant woman and her doctor must know if she is infected with HIV.

What do we know?

• New information gathered shows that a number of women across the United States are not getting tested for HIV during pregnancy.
• 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.
• 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 infant.

What Testing Approaches Are Available?

In the November 15, 2002, Morbidity and Mortality Weekly Report (MMWR), CDC published information on recent prenatal HIV testing rates in the United States and Canada. The report looked at HIV prenatal testing rates when different testing approaches were used. There are two ways to do voluntary HIV testing:

• Opt-in:
  • Pregnant women are given pre-HIV test counseling.
  • They must agree to getting an HIV test, usually in writing.

• Opt-out:
  • 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 test.
  • Unless they decline, they will receive an HIV test.

Statistics published in the 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%. This and other information on prenatal HIV testing suggests that, of the voluntary approaches to prenatal HIV testing, more women are tested with the opt-out approach.

Which Approach Does CDC Recommend?

CDC recommends the opt-out approach, which would make the HIV test a part of the group of tests that all pregnant women receive routinely. Studies show that the opt-out approach can

• Increase testing rates among pregnant women
• Increase the number of HIV-infected women who are offered treatment, and
• Reduce HIV transmission to their babies during birth.

How is 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 them that they may decline this test.
• Give them information about how to prevent HIV transmission during pregnancy and about treatment for pregnant women who are HIV positive.

The opt-out approach offers the best chance that pregnant women will routinely be tested for HIV during pregnancy and, if needed, during labor and delivery. If a woman is HIV positive, knowing her HIV status will reduce the chance that she will pass the virus to her child. Reducing the transmission of HIV from mother to child is a success story, but preventing it entirely has not yet been achieved. Implementation of the opt-out approach is a step to reaching this goal.

Accessibility | Privacy Policy Notice | FOIA