use in pregnancy. Preliminary STEP data indicate that the proportion of HIV-infected pregnant women who receive no prenatal care is 35% for illicit drug users but only 6% for non-drug users.

Testing Offered

Among childbearing women responding to the PRAMS survey in 1996, approximately 75% said their health care worker talked to them about HIV testing during pregnancy (based on the median for the 11 participating states). PGEP data indicate that pregnant women were offered counseling and testing at an even higher rate: overall 88%. The range for the four sites was from 82% to 92% of women reporting that they were offered testing during prenatal care. Multivariable modeling within each site for factors associated with not being offered an HIV test during pregnancy did not find any predictors except in North Carolina where African-American ethnicity and prior testing history were found to be significant. Finally, a preliminary analysis of PRAMS data indicate that certain groups are more likely to be offered testing than others: African Americans and Hispanics (versus whites); young women aged 15 to 19 (versus women over 35); women with less than a high school education (versus more than 12 years of school); women cared for in public care settings (versus private settings); and Medicaid-eligible (versus non-Medicaid-eligible) women.

Testing Accepted

PRAMS data indicate a high test-acceptance rate among childbearing women, with 83% of women offered testing actually receiving the test (median of data from five states). Preliminary data from PGEP provide some information on the reasons women give for not being tested, despite receiving counseling from a health care provider. Overall, women who perceived that the provider gave testing little to no importance were three times as likely to not get tested as women who thought the providers were neutral to supportive of getting a test. Among 1,142 interviewees in public prenatal clinics, the most common response among women who did not get tested focused on timing (i.e., not a good time to be tested or to hear results). In a separate study of 1,134 postpartum women, most of whom delivered in university hospitals, the most common reason given by the 212 women who did not get tested was the woman's assessment that she was not at risk, and the second most common reason given was that the woman had already been tested. Women in the prenatal sample were more likely to have attended a public clinic; women in the postnatal sample were more representative of the general public. Other less common reasons cited in the two surveys were fear of certain components of the test (the needle, blood drawing); fear of discrimination or consequences related to health and life insurance; and belief that the woman's partner did not want her to get tested.



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