Although the committee's charge was focused on prenatal HIV testing and appropriate care, other ways to prevent perinatal transmission of HIV should also be considered. In particular, the committee calls attention to the following areas.
Since perinatal transmission begins with infected mothers and their partners, primary prevention of HIV can contribute markedly to preventing perinatal transmission by lowering the number of HIV-infected women and their male partners. There are many established approaches to primary prevention: HIV/AIDS education programs, behavioral interventions, partner notification, treatment and prevention of sexually transmitted diseases, and community programs. Beyond more general HIV prevention efforts, prevention and treatment programs targeting drug users appear to be especially vital for preventing perinatal HIV transmission.
Pregnancies that are intended—consciously and clearly desired—at the time of conception are in the best interest of the mother and the child (IOM, 1995b). If a woman is infected with HIV, unintended pregnancy and childbearing clearly have special significance. For these reasons, preconception counseling represents an important opportunity to identify HIV-infected women who are considering pregnancy. Some women who know they are HIV-infected choose to become pregnant, especially now that the ACTG 076 regimen is available, but others become pregnant unintentionally. More women learn their HIV status through the course of their pregnancy. Nevertheless, improved knowledge of the consequences of unintended pregnancy (including HIV transmission) and the ways to avoid it, as well as access to contraception, can help to ensure that all pregnancies are intended (IOM, 1995b), and this would reduce, to some extent, the number of children born with HIV infection. The committee does not want to restrict reproductive choice (Faden et al., 1991), but notes that interventions for such women who choose to terminate unintended pregnancies can also be beneficial in reducing the number of children born with HIV infection.
Roughly 15% of HIV-infected pregnant women, many of whom are drug users, receive no prenatal care. Efforts to increase the proportion of women, especially drug users, who receive prenatal care should therefore be a high priority.