Ask Your Midwife Elizabeth Stein, Certified Nurse Midwife Ask your Midife Articles
HIV Testing

By Elizabeth Stein, CNM

My state requires that all pregnant women be tested for HIV. If I test positive, will my baby definitely have HIV?

HIV is a very serious viral infection. There are treatments but no cure, so it is very important to prevent transmission from mother to baby. The risk of the baby becoming infected with HIV depends on the pregnant woman. If the mother is HIV negative, her baby will be negative also. If the mom is HIV positive and does not receive medication, her baby has approximately a 25 percent chance of becoming infected with HIV. Medications may decrease the chance of HIV transmission to between 2 and 8 percent.

ACOG recommends an HIV test at the first prenatal visit. This test is voluntary. If a woman declines the test and she is HIV positive, she misses an important window of opportunity to begin treatment for herself and her fetus. The risks of not being diagnosed with HIV infection are serious. Her infection may worsen. She may become sicker, increasing the chance of infecting her baby as well as her partner. Or she may unwittingly pass the virus to her child through breast milk.

Being tested for HIV is scary, but it's one of the most responsible things a woman can do during pregnancy. In some states, such as New York and Connecticut, it is mandatory for the newborn's HIV status to be known at the time of delivery. If the woman has declined to be tested, the umbilical cord blood is tested when the baby is born. If the HIV test on umbilical cord blood is positive, medication should be started immediately, since treatment started on the newborn within 48 hours of birth (sooner is more effective) decreases the chance of infection from 25 percent to approximately 8 percent. Treatment for the newborn started after 48 hours basically has no effect on transmission. HIV positive umbilical cord blood represents maternal infection and fetal exposure to the virus, not newborn infection.

If the mom is HIV positive, it takes 6 to 18 months to determine the HIV status of her newborn, depending on which tests are done and if she is enrolled in an HIV study.

If you are HIV positive, breastfeeding is not recommended in this country for two important reasons. An HIV positive mother who breastfeeds runs a 14 percent chance of infecting her baby through breast milk. And there is an excellent alternative in infant formulas.

You don't have to wait until you're pregnant to get an HIV test. In fact, it is much better to be tested before considering pregnancy. HIV testing can be done at your annual checkup or gynecological exam. Ask your midwife or doctor. Testing is also available through public health facilities and Planned Parenthood.

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