Perinatal transmission can occur antepartum (during pregnancy), intrapartum (during labor and delivery), and postpartum (after birth), but most mother-to-infant transmission appears to occur intrapartum. The ACTG 076 protocol showed that antiretroviral therapy could reduce perinatal transmission to 8% in some populations (Connor et al., 1994), and subsequent studies have suggested that rates of 5% or lower are possible.
To maximize prevention efforts, women must be identified as HIV-infected as early as possible during pregnancy. Early diagnosis of HIV infection allows the mother to institute effective antiretroviral therapy for her own health. This treatment is also capable of significantly reducing perinatal transmission. HIV-infected pregnant women can also be referred to appropriate psychological, social, legal, and substance abuse services. Babies born to HIV-positive mothers can be started on ZDV within hours of birth, as in the ACTG 076 regimen. Mothers who know they are HIV-positive can be counseled not to breast-feed their infants.
In terms of preventing perinatal transmission, newborn HIV testing has fewer benefits than maternal testing. When maternal serostatus is unknown, however, newborn HIV testing permits early identification and evaluation of exposed infants, allows for initiation of Pneumocystis carinii pneumonia (PCP) prophylaxis in the first months of life to prevent life-threatening bouts of PCP infection, may prevent transmission through breast-feeding or in future pregnancies, and could lead to mothers being treated for their own infection.
Women and children in the United States, including those at risk for or with HIV/AIDS, receive their health care from a variety of sources. Their care is financed by a mixture of public and/or private insurance and public funds. Its content and quality are influenced by public and professional organizations. Its oversight and regulation are achieved through a combination of national, state, and local authorities. Major modifications in Medicaid and welfare programs, the increasing number of uninsured, and the growing presence of managed care in both the public and the private sectors, are having a significant impact on the health care system, affecting not only the availability of quality services, but access to those services as well.
The federal government, with support from state and sometimes local governments, as well as foundations, charitable agencies, and other groups, has established special programs to provide HIV- and AIDS-related care to women and children. All states and territories have an AIDS program funded by the