Unknown human immunodeficiency virus status and associated risk factors among pregnant women in the United States: findings from the 2013 behavior risk factors surveillance system.

Background: Although prenatal Human Immunodeficiency Virus (HIV) infections are declining in the United States, many women of child bearing age are unaware of their HIV status. HIV testing before or during the early stages of pregnancy is a critical first step to reduce the risk of mother-to-child transmission. Objective: The aim of this study was to estimate prevalence of women with unknown HIV status and to explore the associations between socio-demographic characteristics, health care access and HIV testing among pregnant women in the United States. Methodology: Data from the 2013 Behavior Risk Factors Surveillance System (BRFSS) were used to calculate estimates of HIV testing prevalence among pregnant women in the United States (n=2,722). Pregnant women who never had an HIV test or had not been tested for HIV within the past year were considered as pregnant women with unknown HIV status. Descriptive statistics, Chi-square tests and logistic regression were done using SAS Proc Survey procedures, to account for BRFSS’s multistage complex survey design and sample weights. Results: Overall, 30.3% of pregnant women had never been tested for HIV and among these women, only 24% had past-year HIV testing. Non-Hispanic whites (p<0.0001), those aged 18-24 years (p=0.02), married women (p=0.02), those with no insurance (p<0.001) and no personal doctor (p=0.02) had significantly higher rates of no lifetime HIV testing. Pregnant women aged 35-44 years (39.2%), those with annual income of $50,000 or more (32.9%) and those who were married (31.4%) had significantly higher rate of no past-year HIV testing. Multiple logistic regressions showed that the likelihood of having never been tested for HIV was greater among non-Hispanic whites (aOR=2.1; 95% CI:1.3– 3.4; reference=other races), married women (aOR=1.7; 95% CI:1.1–2.3; reference=unmarried), those aged 18-24 years (aOR=2.1; 95% CI:1.4–3.3; reference=35 years old or more), and those who had no insurance (aOR=2.2; 95% CI: 1.3–3.7; reference=covered by insurance). Among those who ever had an HIV test, married women were two times more likely to have no past-year HIV testing than unmarried women (aOR=2.0; 95% CI:1.3–3.1; reference=unmarried); while, younger women (18-24 years old) were less likely to have no past-year HIV testing (aOR=0.3; 95% CI: 0.2–0.7 reference=35-44 years old). Conclusion: Our findings indicated that prevalence of unknown HIV status (lifetime and recent) was high, raising concerns about the prenatal HIV testing approaches in the United States. The likelihood of having never been tested for HIV was greater among non-Hispanic whites, married and younger (18-24 years old) women, and those who had no insurance after controlling for covariates. In addition, the results showed that married women had higher likelihood of having no recent HIV test; while, younger women (18-24 years old) were less likely to have no past-year HIV testing. Our findings highlight the need to continue and strengthen efforts to prevent perinatal HIV transmission in the United States through increasing HIV testing awareness. Health care providers should recommend HIV testing to all women of childbearing age, regardless of sociodemographic characteristics to reduce this mode of transmission.