Getting tested is important because mothers infected with the virus can transmit it to their babies unless medication is given to reduce the risk of transmission. Researchers at the Atlanta-based CDC say they're not sure if so many women are going untested because an HIV test isn't offered to them or because they choose not to have it.
National guidelines in effect since 1995 call for all pregnant women to be tested. In the August issue of the American Journal of Public Health, CDC researchers tracking testing trends say 56% of pregnant women had an HIV test in 1999, up from 41% four years earlier.
That leaves 44% who are never tested. The data come from a survey of more than 30,000 women aged 18-44.
Pregnant women who were unemployed, aged 18-24, never married, had health insurance, and lived in the South were more likely to be tested. Those less likely to be tested presumably were not frequently seen by a doctor since they tended to either have never had a Pap smear or hadn't had one in more than a year, according to lead author Amy Lansky, MPH, PhD, of the CDC's National Center for HIV, STD, and TB Prevention.
James E. Ferguson, II, MD, an ob-gyn at the University of Virginia, Charlottesville, says it is mandatory for him to offer the test, but it's up to the woman to decide whether she wants it.
Ferguson says one way of boosting the numbers of women getting tested is by including HIV testing with other routine tests.
"We tell them it's part of the prenatal package unless they decline," says Ferguson. "We've tried to make it more of an automatic thing that is done but still preserve the decision making and autonomy of the pregnant woman."
Fear of being stigmatized, thinking she is not at risk for HIV, or fearing negative feedback from her insurance company may all be reasons a woman decides not to get tested, says Ferguson. But he says more research is needed to confirm that women not being tested are making the decision for themselves.
Another possibility is that these women already know their HIV status, explains Margaret A. Fischl, MD, director of the Comprehensive AIDS Program at the University of Miami School of Medicine.
But Fischl says the bulk of women who account for those who don't get tested likely are women who don't think they are at risk because they've been with the same partner for years, have never used drugs, and have no other apparent risk factors. These women are the most difficult to sell on the idea of testing.
"It's not an ideal moment in time to do this, and [women] will tell you that," Fischl says. "This is supposed to be a joyous time in their lives ... and it raises unwanted questions about their partner. They get very traumatized when you say 'HIV.'"