Disparities Exist In Prenatal HIV Testing

Despite a government directive, not every pregnant woman receives an HIV test that could potentially save the life of her unborn child. Race and site of medical care determine which women get tested, according to a new study conducted by researchers at Brown Medical School and University of Massachusetts Medical School.

Results are published in a special supplement to the Journal of the National Medical Association on HIV/AIDS in racial and ethnic minority populations.

“What we learned is disturbing,” said Deborah Pearlman, assistant professor (research) in Brown’s Department of Community Health and lead author of the report. “In 2001, the Centers for Disease Control and Prevention called for universal voluntary HIV testing for pregnant women – regardless of race, age, class or risk factors. Yet this isn’t the case. The results of our study suggest that doctors may be making selective decisions about which pregnant women get HIV counseling and testing.”

For the study, researchers sampled 433 pregnant and postpartum women enrolled in the Massachusetts Women, Infants and Children (WIC) program, a federally funded nutrition program. The women, all of whom earned less than $25,000 a year, received medical care in public and private medical offices throughout the state. The race and ethnicity of women enrolled in the study – 36 percent black, 34 percent white, 28 percent Hispanic, 2 percent other race – reflected the composition of the female HIV-infected population in Massachusetts in 2001, when the study was conducted.

Researchers gave the women a self-administered questionnaire, which asked about HIV counseling and testing during pregnancy, among other topics.

What Pearlman and her team found: Overall, only 70 percent of women got an HIV test while pregnant. And disparities existed. In publicly funded health centers, clinics and hospital outpatient clinics, black and Hispanic women were more likely to get tested – 85 percent and 83 percent, respectively, compared to 70 percent of white women.

“One question that arises from the data: In public health settings, is there profiling by health care professionals to counsel and test more women who ‘look like’ they are at high risk for HIV?” said Sally Zierler, professor of medical science at Brown and co-author of the study. “What we can say, more definitively, is that prenatal HIV testing should be offered to all women.”

Pearlman noted that antiretroviral drugs have dramatically reduced mother-child transmission of HIV if given during pregnancy. But reliance on treatment, Pearlman said, isn’t enough. “In Massachusetts, we found a 3.5-percent increase in the number of HIV-positive women of childbearing age between 1999 and 2001, with no decline in these numbers in 2003,” she said. “This makes it increasingly important to keep HIV counseling and testing an integral part of prenatal care.”

When presented with the study findings two years ago, the Massachusetts Department of Public Health offered HIV training to providers caring for pregnant women and instituted performance expectations that emphasized the government guidelines. The aim is to ensure that all pregnant women get HIV counseling and testing and that those who need treatment receive it.

Abigail Averbach, senior project director at University of Massachusetts Medical School’s Center for Health Policy and Research, and Kevin Cranston, director of the HIV/AIDS Bureau at the Massachusetts Department of Public Health, also conducted the research. The Centers for Disease Control and Prevention funded the work.

From Brown University

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