Perinatal HIV: Decline, but disparities persist

Rates still much higher in black, Hispanic children

Although the total number of annual perinatal HIV infections in the United States has decreased approximately 90% since 1991 — and continue to fall in the most recent data set from 2004-2007 — racial/ethnic disparities persist, the Centers for Disease Control and Prevention reports.

Racial/ethnic disparities in the incidence of HIV/AIDS among children have been documented since 1981-1986, when 78% of children with AIDS were black or Hispanic. These racial/ethnic disparities have been reflected in rates of perinatal HIV infection. Of all reported diagnoses of perinatal HIV infection during 2004-2007, 85% were in children who were black or Hispanic, and rates were several-fold higher among black and Hispanic children than among white children.1

"To eliminate perinatal transmission and racial/ethnic disparities, continued measures are needed, including primary HIV prevention for women, reproductive health and family planning for women with HIV infection, and prenatal care and early treatment with antiretroviral medications for pregnant women and their infants," the CDC states.

These disparities are directly related to the racial/ethnic distribution of women diagnosed with HIV infection. High-risk heterosexual transmission remains the principal source of exposure for HIV-infected women of all races/ethnicities, accounting for 80% of new infections among women. Recent studies also have suggested that the higher rates of HIV infection among blacks in the United States are related to a number of social factors, such as tight social networks, mixing, and poverty.2 In addition, in a study of women enrolled in Medicaid during 1995-1997, black (71%) and Hispanic women (74%) were significantly less likely than non-Hispanic white women (81%) to initiate prenatal care in the first trimester and less likely (62% and 69% versus 72%, respectively) to make an adequate number of prenatal care visits, indicating that black women would have less opportunity for timely HIV testing and early initiation of antiretroviral prophylaxis to prevent perinatal transmission.3

Further reductions in perinatal HIV transmission are achievable, toward an elimination goal of <1% among infants born to HIV-infected women and <1 transmission per 100,000 live births. Primary HIV prevention in women is the best way to prevent HIV infection in children. All women with HIV infection should have reliable access to comprehensive HIV treatment and primary women's health care to optimize their health before pregnancy and receive effective contraception to avoid unintended pregnancy. To eliminate perinatal HIV transmission, all HIV-infected pregnant women must 1) receive a diagnosis of HIV infection before or early in pregnancy, 2) receive prenatal care, 3) adhere to an antiretroviral medication regimen during pregnancy, 4) have a scheduled cesarean delivery at 38 weeks' gestation if viral suppression has not been achieved, and 5) receive antiretroviral medication during labor and delivery. Antiretroviral medication also should be provided to HIV-exposed newborns within the first hours after birth and for the first 6 weeks of life.

References

  1. Centers for Disease Control and Prevention. Racial/Ethnic Disparities Among Children with Diagnoses of Perinatal HIV Infection—34 States, 2004—2007. MMWR 2010;59(04):97-101
  2. Aral SO, Adimora AA, Fenton KA. Understanding and responding to HIV and other sexually transmitted infections in African Americans. Lancet 2008;372:337--40.
  3. Gavin NI, Adams EK, Hartmann KE, et al. Racial and ethnic disparities in the use of pregnancy-related health care among Medicaid pregnant women. Matern Child Health J 2004;8:113--26.