Eradicating Perinatal HIV Transmission Is Possible: A Model for Social Work Practitioners

Abstract

Since 1994, medical research has shown that zidovudine, given to HIV-seropositive women during pregnancy and their newborns, reduced the risk of perinatal HIV transmission (Centers for Disease Control and Prevention [CDC], 2007; Connor et al., 1994). Over the past decade, the number of perinatally acquired AIDS cases has steadily decreased (CDC, 2007). Yet perinatal HIV transmission remains the most common route of HIV in children (CDC, 2007). Perinatal transmission is of great concern for Hispanic and African American communities. Of the people living with HIV/AIDS who were perinatally infected, 20 percent were Hispanic or Latino, and 66 percent were African American (CDC, 2007). Thus, identifying HIV-positive pregnant women may allow health care professionals to administer the necessary treatment and provide services needed to prevent an unborn baby from having a seropositive status. Notwithstanding that prevention efforts have had major success, the continued incidence of perinatally acquired AIDS among infants documents ongoing perinatal transmission and underscores the need for strategies to ensure that women receive HIV counseling and voluntary testing during prenatal care. Social work practitioners are in a pivotal position to provide education to women of childbearing age about the importance of HIV testing during prenatal care. This column introduces perinatal HIV transmission health knowledge and a comprehensive model that may be useful for social work practitioners to address this issue with clients and educate staff who work with women of childbearing age to help relieve the anxiety and stress of getting tested. HEALTH CARE PAST RECOMMENDATIONS In an effort to reduce pediatric AIDS cases and to improve treatment for mothers with AIDS, the U.S. Institute of Medicine committee recommended universal testing for HIV as a routine part of prenatal care (CDC, 1999). The decision to provide HIV counseling and offer HIV testing is a recommendation, rather than a mandate, for health care professionals and physicians. Universal testing for HIV was added in 1997 to the American College of Obstetricians and Gynecologists (ACOG) guidelines as a recommendation. Therefore, physicians and other health care professionals make the decisions of offering HIV counseling and testing for their individual practices. Establishing HIV testing as a routine part of prenatal care may help to normalize HIV testing for pregnant women and minimize the stigma associated with the disease. Minimizing the stigma associated with HIV testing may allow physicians and other health care officials to avoid offering screening tests, which can cause physicians to make assumptions based on external factors (that is, where people live, race, marital status). HEALTH CARE CURRENT RECOMMENDATIONS In May 2000, ACOG launched a campaign to educate its members and to make HIV screening of pregnant women a routine part of care (ACOG, 2004). The ACOG then proceeded to convince its 40,000 members to include HIV testing in the standard battery of prenatal tests. This issue is a top priority for ACOG and deserves research to explore issues of HIV testing for women during prenatal care (ACOG, 2004). In 2006, CDC published recommendations that, regardless of recognized risk factors, everyone between 13 and 64 years of age be screened for HIV (CDC, 2006). Those efforts, along with rapid screening tests to detect HIV infection in pregnant women and universal prenatal counseling and voluntary testing, have increased the proportion of HIV-infected women who are diagnosed and treated before delivery (Chou & Huffman, 2007). Detecting HIV in pregnant women allows health care professionals to recommend regimens of highly active antiretroviral therapy (HAART), thus leading to significantly reduced rates of mother-to-child transmission (Chou & Huffman, 2007). Furthermore, ACOG currently recommends routine HIV screening for women ages 19 to 64, regardless of pregnancy status or risk factors, and screening for women outside this age range who are at high risk (ACOG, 2008). …