Book Review—Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States

Abstract

Institute of Medicine, Committee on Perinatal Transmission of HIV. (1999). Reducing the odds: Preventing perinatal transmission of HIV in the United States. Stoto, M. A., Almario, D. A., & McCormick, M. C. (Eds.). National Academy Press: Washington, D.C. In 1994, the results of the AIDS Clinical Trials Group protocol number 76 (ACTG076) showed that perinatal transmission of AIDS to the fetus and newborn could be reduced by approximately 2/3 through the administration of the antiretroviral drug, zidovudine. As a result, various government agencies and professional organizations developed recommendations for counseling and testing all pregnant women for HIV. According to the Institute of Medicine, this approach appears to have been successful to some degree. However, a more formal evaluation of the process was mandated by the U.S. Congress to determine the effectiveness of programs designed to reduce perinatal transmission of HIV and to identify barriers to the reduction of HIV transmission. To perform this task, the Institute of Medicine formed the Committee on Perinatal Transmission of HIV, which was comprised of 13 members with diverse areas of expertise pertinent to the objectives of the committee. Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States is the committee's report of its findings and its recommendations for improving the existing guidelines. This publication is both a concise and a complete guidebook to HIV and pregnancy. The inclusion of appendices describing site visits to a number of HIV prevention programs in New York, New Jersey, Alabama, South Texas, and Florida is enlightening. Also valuable are appendices that provide excerpts from the Ryan White CARE Amendments of 1996 and the 1995 U.S. Public Health Service recommendations for HIV counseling and testing for pregnant women. The report itself includes information on the epidemiology of the perinatal transmission of HIV and the natural history, detection, and treatment of infected pregnant women and newborns. The implementation and impact of the U. S. Public Health Service guidelines for HIV testing and counseling are described contextually with the community services available for such programs. Finally, the committee's recommendations are presented. The main recommendation is a national policy of universal HIV testing, along with patient notification and the right to refuse. All other recommendations are geared toward implementation of this policy and improved access to care for HIV-positive women. Specific recommendations address education of prenatal care providers regarding the value of HIV testing, and the development of clinical practice guidelines and policies that promote universal prenatal HIV testing. An important point childbirth educators can take from this book comes from the committee's recommendation for education to respond to pregnant women's misgivings about HIV testing. Herein lies an opportunity to impact the rate of perinatal transmission of HIV. For example, in Seattle, Washington, as part of a comprehensive plan to increase perinatal testing for HIV, the Group Health Cooperative of Puget Sound, a large HMO affiliated with Kaiser Permanente, includes HIV education and counseling in prenatal classes. Women who understand the process of testing and the benefits of treatment have an improved ability to make truly informed decisions for the better health of themselves and their babies. Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States provides a positive model for the development and implementation of programs designed to reduce the numbers of newborns infected with HIV. Healthier mothers and babies have always been the main focus of childbirth education.