1 November 1999

During the early 1990s, before perinatal preventive treatments were available, an

estimated 1,000-2,000 infants were born with HIV infection each year in the United

States. Today, the United States has seen dramatic reductions in mother-to-child, or

perinatal, HIV transmission rates. These declines reflect the widespread success of

Public Health Service (PHS) recommendations made in 1994 and 1995 for routinely

counseling and voluntarily testing pregnant women for HIV, and for offering

zidovudine (AZT) to infected women during pregnancy

and delivery, and for the infant after birth.

On a national level, HIV/AIDS surveillance and other

studies continue to demonstrate that perinatal HIV

prevention is making a difference, both in terms of lives

and resources saved:

v Between 1992 and 1998, perinatally acquired AIDS

cases declined 75% in the United States.

v A study conducted in four states (Michigan, New Jersey, Louisiana, and South

Carolina) found that the proportion of pregnant women voluntarily tested for HIV

increased from 68% in 1993 to 79% in 1996. The percentage of women offered

AZT increased from 27% in 1993 to 85% in 1996. However, the study also

found that 15% of HIV-infected pregnant women in these states did not receive

prenatal care and therefore could not be offered this intervention.

v Among women in CDC’s Perinatal AIDS Collaborative Transmission Study

(PACTS), AZT use increased following the publication of PHS guidelines,

and the rate of perinatal transmission dropped from 21% to 11%. The PACTS

study includes women from four cities–New York City, Newark, Atlanta,

and Baltimore.

v Prenatal care that includes HIV counseling and testing and AZT treatment for

infected mothers and their children saves lives and resources. Without intervention, a 25% mother-to-infant transmission rate would result in the birth of an

estimated 1,750 HIV-infected infants annually in the United States, with lifetime

medical costs of approximately $282 million.

v The estimated annual cost of perinatal prevention in the United States is $67.6

million. This investment prevents 656 HIV infections and saves $105.6 million in

medical care costs alone–a net cost-savings of $38.1 million annually.

HIV transmission from mother to child during pregnancy, labor, and delivery or by

breast-feeding has accounted for 91% of all AIDS cases reported among U.S.

children. The best ways to prevent infection in children are to prevent infection in

women and to encourage early prenatal care that includes HIV counseling and

testing.

H I V

Prevention Status of Perinatal HIV Prevention:

U.S. Declines Continue

Perinatal Prevention Saves Lives and Dollars
 2 November 1999

Women of color and their children have always

been disproportionately affected by the HIV

epidemic. In 1998, of the 10,998 total AIDS

cases reported among U.S. women, 8,830

(80%) were among African American and

Hispanic women. Of the 382 children reported

with AIDS in 1998, 321 (84%) were African

American and Hispanic (see chart). We must

continue to improve HIV prevention efforts for

women of color and ensure that interventions

provide the information, skills, and support

needed to reduce their HIV-related risks.

What Else Is Needed?

v Perinatal HIV prevention activities must help ensure that all HIV-infected women are reached early in

pregnancy with prenatal care and with the opportunity to learn their HIV status. If infected, they should be

offered preventive therapy to improve the chances that their children will be born free of infection and to

ensure quality HIV care and treatment for mothers and their babies. Achieving this goal will require increased access to and use of prenatal care.

v Women who use drugs during pregnancy are the least likely to get prenatal care. Increased efforts

are needed at all levels (community, state, national) to integrate substance abuse and HIV prevention

activities and assist pregnant women in accessing needed services to improve their own health and the health

of their babies.

For information about national HIV prevention activities, see the following CDC fact sheets:

* CDC’s Role in HIV and AIDS Prevention

* Linking Science and Prevention Programs— The Need for Comprehensive Strategies

Internet Resources:

National Center for HIV, STD, and TB Prevention:

 http://www.cdc.gov/nchstp/od/nchstp.html

Divisions of HIV/AIDS Prevention:

 http://www.cdc.gov/hiv

National Prevention Information Network:

 http://www.cdcnpin.org

For more information...

CDC National AIDS Hotline:

1-800-342-AIDS

Spanish: 1-800-344-SIDA

Deaf: 1-800-243-7889

CDC National Prevention Information Network:

P.O. Box 6003

Rockville, Maryland 20849-6003

1-800-458-5231

Perinatal HIV Transmission Heavily Affects Communities of Color

AIDS Cases

N=382

U.S. Children

N=51,603,000

AIDS Cases in Children <13 Years of Age Reported in 1998

and 1998 Population Estimates of Children by Race/Ethnicity,

United States

White, not Hispanic

Black, not Hispanic

Hispanic

Asian/Pacific Islander

American Indian/

 Alaska Native

1%

62%

22%

15%

63%

17%

14%

1%

4%