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Executive Summary
In the United States,
the incidence of infection with the human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS) has increased among women of childbearing age. For instance, in 1994,
approximately 22% of the 68,171 cases of HIV infection reported among adults and
adolescents were female and 1,159 (1.7%) cases were pediatric HIV infection. In February
1995, the Centers for Disease Control and Prevention (CDC) reported that women accounted
for 18.1% of the 440,000 reported AIDS cases. This percentage is twice as high as the
percentage of women among the first 100,000 reported cases of AIDS (9%). Projections for
the year 2000 indicate that at the current pace, as many as 125,000 children and
adolescents will have lost their mothers to HIV/AIDS in the United States.
As of January 1997, Michigan ranked 17th in total HIV/AIDS cases reported; ranked 36th by
annual rate per 100,000 population in the United States; and reported a cumulative total
of 88 perinatal HIV cases. Of the 88 infants born with HIV, 42 (53%) were female.
Moreover, since 1990, the annual reported incidence of women and children (age 0-13) with
AIDS has tripled, while approximately 2 in 7 of the infants born to HIV infected women
each year are infected with the virus.
Studies on HIV/AIDS have shown that reductions in perinatal HIV transmission would
significantly reduce the number of children with AIDS. The Michigan Department of
Community Health (MDCH) Maternal and Child Health Advisory Committee convened the
Subcommittee on Perinatal HIV Reduction in March 1996 to examine the CDC Guidelines aimed
at reducing the perinatal transmission of HIV and tailor them to the specific needs of
Michigan residents. A 60 member advisory committee was selected from a variety of
organizations serving women, children and infants, and also included consumers. The
primary focus of the Subcommittee centered on the "CDC Recommendations for Universal
Counseling and Voluntary Testing for HIV of Pregnant Women" and the "Clinical
Guidelines for the Use of Zidovudine Therapy in Pregnancy to Reduce Perinatal Transmission
of HIV", as developed by the New York State Department of Health - AIDS Institute.
The CDC Recommendations for Universal Counseling and Voluntary Testing for HIV of Pregnant
Women were written and issued for pregnant women in the United States with the goal of
providing the best opportunity for pregnant women to be educated about HIV, its
transmission, and to learn their infectious status. These recommendations call for routine
HIV counseling and voluntary testing of all pregnant women. Women who are HIV infected can
be offered interventions to reduce the risk of perinatal and other transmission and obtain
needed follow-up care for themselves and their infants. The Subcommittee supports these
recommendations and has modified them specifically for implementation in Michigan. The
purpose of HIV testing is not to label a woman as infected, but rather to engage her and
her child in appropriate health care. This is most likely to occur when a woman feels she
has participated in decisions regarding her own and her child's health. The first portion
of this document contains these guidelines adapted by the Subcommittee for use in
Michigan.
The Clinical Guidelines for the Use of Zidovudine Therapy in Pregnancy to Reduce Perinatal
Transmission of HIV section deals with the results of the National Institutes of Allergies
and Infectious Diseases' (NIAID) AIDS Clinical Trial Group (ACTG) protocol No. 076. The
study, sometimes referred to as ACTG 076, demonstrated a substantial reduction in the
transmission of HIV from mothers who were HIV positive to their infants when mothers and
their infants were treated with zidovudine (AZT/ZDV). The study indicated that mother to
child HIV transmission decreased from 25.5% to 8.3% for those mother/infant pairs who
received antepartun, intrapartum and newborn AZT/ZDV therapy. These guidelines, since
revised, represent the current standard of care therapy to reduce perinatal transmission
of HIV
Maternal and child health providers serve more than 16 million women, infants, children
and youth and provide prenatal care for roughly one-third of all pregnant women in the
United States. With the ability to reach so many women and infants with effective maternal
and child health services, state maternal and child health programs serve a central role
in developing and implementing policies and programs that support the delivery of
preventive health services to women and infants-services that have the potential to not
only result in reducing perinatal transmission of HIV infection, but also to promote
earlier intervention and earlier referral to care. It is important to note that substance
abuse treatment and prevention providers play an important role in serving women and
children and must be included in the group of maternal and child health service providers,
along with the many private providers that serve women, children, adolescents and
families.
This reference document should be kept readily available in the office of all providers
that serve women, children and adolescents. The summarized recommendations are provided
for quick reference; however, the full version of this document is written in a manner
that supports understanding and provides additional references.
Contact the Michigan Resource Center at 1-800-626-4636 for a printed copy of this
document.
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