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Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States (1999)
Institute of Medicine (IOM)

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. "Executive Summary." Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States. Washington, DC: The National Academies Press, 1999.

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  • treatment or intervention for those found positive widely accepted by the scientific and medical community, with evidence that early intervention improves health outcomes.
  • The screening test or measurement should distinguish those individuals who are likely to have the condition from those who are unlikely to have it.
  • There should be adequate facilities for diagnosis and resources for treatment for all who are found to have the condition, as well as agreement as to who will treat them.
  • The test and possible interventions should be acceptable to the affected population.

Descriptive Epidemiology Of The Perinatal Transmission Of HIV

In 1997, women accounted for 21% of AIDS cases in adults, and the proportion of all cases that are among females continues to grow. At least two-thirds of AIDS in women can be attributed to injection drug use either directly or through sex with drug users. Although a subset of women with HIV have injected drugs or have had sex with a known injection drug user, an increasing proportion of women have become infected through sexual activity with men whose risk behaviors were unknown to them. AIDS is more prevalent in African-American and Hispanic women, in women in the Northeast and the South, and in women in large cities. Approximately 6,000 to 7,000 HIV-infected women give birth every year. Trend data show a relatively steady national rate of HIV prevalence in childbearing women between 1989 and 1994, the last year for which data are available.

Perinatal transmission accounted for at least 432 AIDS cases in the United States in 1997. The number of perinatally acquired AIDS cases rose rapidly in the late 1980s and early 1990s, peaked around 1992, and subsequently declined by approximately 43% by 1996. Such data on perinatal AIDS cases reflect the number of children born with HIV infection in previous years, and more recent data are not available because of reporting delays. Changes in the number of perinatal AIDS cases, therefore, are not direct estimates of the impact of prevention activities on perinatal transmission of HIV.

Pediatrics AIDS cases are concentrated in eastern states, and especially in the New York metropolitan area. In 1996, three states alone—New York, New Jersey, and Florida—reported 330 cases. This represents 49% of the diagnosed cases, even though only 15% of children are born in those states (CDC, 1996b; Ventura et al., 1998). In contrast to the concentration of perinatal AIDS cases in the Northeast, they are far less common in most geographical areas. In 1997, 39 states had fewer than ten perinatally transmitted AIDS cases (CDC, 1997c).

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Front Matter (R1-R16)
Executive Summary (1-14)
1 Introduction (15-20)
2 Public Health Screening Programs (21-35)
3 Descriptive Epidemiology of the Perinatal Transmission of HIV (36-44)
4 Natural History, Detection, and Treatment of HIV Infection in Pregnant Women and Newborns (45-53)
5 Context of Services for Women and Children Affected by HIV/AIDS (54-67)
6 Implementation and Impact of the Public Health Service Counseling and Testing Guidelines (68-108)
7 Recommendations (109-133)
References (134-144)
Appendixes (145-146)
A Committee and Staff Biographies (147-154)
B Context of Services for Women and Children Affected by HIV/AIDS (155-189)
C Workshop I Summary (190-202)
D Workshop II Summary (203-235)
E New York/New Jersey Site Visit Summary (236-251)
F Alabama Site Visit Summary (252-259)
G South Texas Site Visit Summary (260-270)
H Florida Conference Summary (271-274)
I HIV Testing and Perinatal Transmission: Thoughts from an HIV-Positive Mother (275-285)
J Human Immunodeficiency Virus Antibody Testing Among Women 15-44: Results from the 1995 National Survey of Family Growth (286-303)
K Details of the Committee's Models and Assumptions (304-312)
L Passing the Test: New York's Newborn HIV Testing Policy, 1987-1997 (313-340)
M Excerpts from the Ryan White CARE Act Amendments of 1996 (341-346)
N 1995 U.S. Public Health Service Recommendations for Human Immunodeficiency Virus Counseling and Testing for Pregnant Women (347-371)
O Acronyms and Glossary (372-376)
Index (377-397)