Date: Wed, 6 Dec 1995 00:01:16 +0500 From: ghmcleaf{CONTRACTOR/ASPEN/ghmcleaf}%NAC-GATEWAY.ASPEN@ace.aspensys.com Subject: CDC Natl AIDS Hotline Training Bull #153 CENTERS FOR DISEASE CONTROL AND PREVENTION HIV/AIDS PREVENTION CDC NATIONAL AIDS HOTLINE TRAINING BULLETIN ................................................................. July 6, 1995 #153 This is a statement from the Centers for Disease Control and Prevention (CDC) concerning women, children, and HIV/AIDS. CDC tracks HIV infection and AIDS in two groups increasingly affected by the epidemic--women and children--through a number of surveillance programs. Information on the status of HIV/AIDs in these groups is critical to plan and evaluate prevention programs, to determine health care resource needs, and to better target services and care to those who need them. Women and Children Increasingly Affected by AIDS Through December 1994, CDC received reports of 58,428 cumulative cases of AIDS among adult and adolescent women (13 years of age and older) in the United States. Women account for more and more AIDS cases--they were only 7% of reported AIDS cases in 1985, but jumped to 18% in 1994. AIDS is now the fourth leading cause of death among women 25-44. And AIDS is actually increasing faster in women than it is in men. In 1994 alone, 14,081 women were reported with AIDS. Women of childbearing age account for the vast majority of those cases: 84% were reported in women 15-44 years old. In 1994, most women with AIDS were infected through injecting drug use--41%. But nearly as many--38%--were infected through heterosexual contact with an infected partner. An additional 19% were initially reported with no specific HIV exposure. Historically, when these cases are investigated, it is found that most of these women--66%--have been exposed through heterosexual sex. Heterosexual contact is the most rapidly increasing transmission category for women. Comprehensive HIV prevention programs for women must address their multifaceted prevention needs. The epidemic in children is closely associated with the epidemic in women. CDC has received reports of more than 5,500 cases among children who were infected with HIV through perinatal transmission (from mother to child during pregnancy, labor, and delivery, or by breastfeeding). In 1994, 1,017 pediatric AIDS cases were reported, an 8% increase from the number reported in 1993. Of these, 92% were mother-to-child transmission. For HIV- infected women of childbearing age, the possibility of perinatal transmission adds an additional important dimension to HIV prevention. In 1993, an estimated 7,000 HIV-positive women gave birth in the U.S. Thatgs 1 out of every 625 live births. Not every baby born to an infected mother is also infected. Without preventive treatment, the mother-to-child transmission rate is 15-30%, or about 1,000-2,000 infants in 1993. AZT Can Reduce Perinatal Transmission Some pregnant women who are infected with HIV but dongt yet have any signs of AIDS can reduce the chances of transmitting HIV to their babies by as much as two-thirds if AZT therapy is begun early in pregnancy, continued through labor and delivery, and provided to the child for the first 6 weeks of life. Based on these findings, the Public Health Service (PHS) issued recommendations in August 1994 on using AZT to reduce the risk of perinatal transmission. And in July 1995, to provide pregnant women the opportunity to learn their HIV status as early in pregnancy as possible, PHS issued guidelines calling for routine counseling and voluntary HIV testing for all pregnant women. If women do not receive prenatal care, or if for any reason their HIV status is unknown at the time of delivery, the guidelines recommend that HIV testing be offered to them or their babies at or shortly after delivery. Implementing these guidelines will reduce the number of children who get AIDS. Just as important, targeted prevention programs for women are critical for the health of both women and children. The best way to prevent infection in babies is to prevent infection in women. Evaluating Prevention Efforts It is critical that resources are directed where they do the most good. To do that, the impact of prevention programs must be continuously monitored and changes made to most effectively target messages and activities. And surveillance is essential to know where HIV infection is decreasing, stabilizing, and increasing so that programs can be directed where they are most needed. In collaboration with community-based organizations, state and local health departments, and other federal and private-sector organizations, CDC is committed to ensuring that both the implementation and evaluation of HIV prevention programs for women and children continue to be priorities in the fight against AIDS. Disclaimer: CDC Hotline Training Bulletins The information in the "CDC Hotline Training Bulletins" is provided by CDC and NIH for use by the CDC National AIDS Hotline in responding to general questions from the public about HIV and AIDS. The bulletins are not intended to be comprehensive discussions of the subject areas. Treatment and drug therapy options change as new research and clinical experiences broaden scientific knowledge. Therefore, persons seeking information on drug therapy should refer to the product information sheet included in all drug packages for the most current and accurate information about a particular drug, especially if the drug is new or infrequently used. HIV-infected individuals should consult their personal physician for specific concerns about their health. For persons desiring more information on a specific topic, public, medical, and university libraries can provide excellent references. The AIDS Clinical Trials Information Service (800-874-2572) can provide information about ongoing HIV/AIDS clinical trials; the HIV/AIDS Treatment Information Service (800-448-0440) can assist with information about the latest treatments for persons with HIV infection or AIDS.