AEGiS-12IAC: State efforts to reduce perinatal HIV transmission.

12th International AIDS Conference

Geneva, Switzerland - June 28-July 3, 1998

State efforts to reduce perinatal HIV transmission.

Int Conf AIDS 1998 Jun 28-Jul 3; 12:959 (abstract no. 44105)

Lazzarini Z, Gostin LO, Ward JW, Fleming PL, Neslund VS
Harvard School of Public Health, Boston, MA, USA.

BACKGROUND: For women with HIV/AIDS, zidovudine taken during pregnancy, birth, and by the baby after birth reduces the risk of perinatal HIV transmission from about 24% to 8%. The United States (US) Public Health Service (PHS) recommends that all pregnant women receive education, counseling and testing (with consent) for HIV infection, followed by antiretroviral treatment for women with HIV/AIDS, and monitoring of newborns to provide early treatment for those infected. Policy-makers need to assess state efforts to comply with PHS guidelines and other preventive measures.

METHODS: We surveyed 50 states, the District of Columbia (DC) and the US territories to collect laws, regulations, policies and programs intended to implement PHS guidelines through education, counseling, testing, and treatment of pregnant women and monitoring and treatment of newborns exposed to HIV.

RESULTS: As of 2/98, 45 states/territories have responded. The majority of states have policies or guidelines to prevent perinatal HIV transmission. 87% have policies on counseling and/or testing of pregnant women, 77% on treatment of pregnant women, and 44% on testing, monitoring or treatment of newborns. Only 36% states have adopted laws or regulations on HIV counseling and testing of pregnant women: 28% require HIV testing be voluntary; 2% routinely test women but permit them to "opt out"; and none mandate testing. Fewer states (22%) have laws or regulations regarding testing, monitoring or treatment of exposed newborns. 13% expressly permit testing of newborns without parental consent. Most laws regarding disclosure of test results mirror state HIV confidentiality provisions. 55% of states criminalize international HIV transmission. 13% of states have proposed or pending legislation in one of the areas surveyed. Virtually all states have programs to disseminate educational information to health care providers, pregnant women and the public. States report ongoing assessments of practices of providers serving pregnant women (58%), and newborns (31%), as well as the impact of the PHS guidelines on rates of perinatal HIV transmission (33%). State assessment projects planned for practices related to pregnant women or newborns (26%) and perinatal transmission (28%).

CONCLUSIONS: States have moved rapidly to implement PHS guidelines. The majority of states have policies, fewer have formal legislation. Most efforts rely on education, counseling and testing (with consent) of pregnant women. Treatment of pregnant women is mostly covered by policies. Fewer states have laws or policies regarding newborns. State efforts include little mandatory or coercive actions. Policy-makers should consider ongoing evaluation data before changing existing state efforts.

Keywords: AEGIS, HIV Infections, Zidovudine, Acquired Immunodeficiency Syndrome, Counseling, HIV Seropositivity, Antiretroviral Therapy, Highly Active, Prenatal Care, Parturition, United States, Health Services Needs and Demand, Mass Screening, Research Design, District of Columbia, Pregnant Women, Human, Female, Infant, Infant, Newborn, Pregnancy, transmission, therapy, drug therapy, ICA12
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