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Mother-to-Child HIV Prevention
Antiretroviral treatment is highly effective at preventing transmission of HIV perinatally. Specific provider-initiated and patient-initiated interventions can protect children before and after birth.
What is mother-to-child HIV prevention?
Mother-to-child HIV prevention is making sure women who are living with HIV do not transmit the virus to their babies. To accomplish this, all women of child-bearing age need to know their HIV-status, and pregnant women who have tested positive and their babies need special care, including antiretroviral treatment (ART). (For information on CDC guidance and recommendations for prevention of mother-to-child transmission of HIV, refer to: http://www.cdc.gov/hiv/pwp/reproductive.html)
Why do it? What are the benefits?
- Prevents most cases of HIV infection in children
- Reduces risks to less than 1% for transmitting the virus to her unborn child for HIV-positive women who achieve viral suppression on ART
What are some of the barriers to mother-to-child HIV prevention?
- Inadequate prenatal and perinatal HIV testing, including testing only women perceived as high risk for infection and not retesting women who have previously tested negative
- Limited access to family planning services, prenatal and perinatal care, and HIV testing
- Lack of awareness of HIV risks, risks to unborn children, and available services
- Domestic violence, substance abuse, and low socioeconomic status
- Lack of experience treating women living with HIV
What are some strategies to improve prevention of mother-to-child transmission of HIV?
- Conduct HIV testing on an opt-out basis, as determined by state laws, for all patients
- Do follow-up testing during the third trimester of pregnancy for women who initially test HIV negative
- Provide rapid HIV antibody testing for women who present in labor and have an undocumented HIV status and, for women who test positive, initiating antiretroviral treatment (ART) while awaiting confirmatory test results
- Prescribe ART for all women living with HIV who are pregnant or planning to become pregnant, regardless of CD4 cell count
- Choose caesarean delivery for women living with HIV
- Treat infants born to women living with HIV with ART
- Avoid breastfeeding and premastication of food
Who is involved to make it work?
Everyone who provides services to women of child-bearing age shares responsibility for educating women about potential HIV transmission risks, especially prenatal and perinatal transmission risks, and referring them to appropriate care. Clinicians, case managers, and counselors have particular responsibility to ensure that pregnant women are connected to care, tested for HIV, and, for women living with HIV, engaged in appropriate measures to minimize transmission risks to their unborn children during childbirth.