United States Inches Toward Eradicating Perinatal HIV, but Disparities Remain

By: Ranier Simons, ADAP Blog Guest Contributor

Despite the many advances in medical science, there is still no cure for HIV. In 2021, 38.4 million people were living with HIV. Approximately 36.7 million were adults, 1.7 million were children 15 years of age or younger, and 54% were women or girls.[1] There were 1.5 million new HIV infections globally as well.[1] These numbers are high, but all the data regarding HIV is not bad. While there is still a good deal of work to be done, perinatal HIV is nearly eradicated in the U.S. Perinatal HIV is HIV passed from mother to child during pregnancy, delivery, and childbirth, or through postpartum breastfeeding.[2]

Photo Source: HIV.gov

In 2012, the Centers for Disease Control & Prevention (CDC) published a framework for eradicating perinatal HIV in the United States. The framework contained a two-prong goal: reduce the incidence of perinatal HIV to fewer than 1 case per 100,000 live births and to reduce the transmission rate to less than 1 percent (less than 1 per 100 live births) in babies born to HIV-positive mothers. Using National HIV Surveillance System data, researchers recently published findings examining perinatal HIV information from 2010-2019. The number of live births to HIV-positive women decreased from 4587 in 2010 to 3525 in 2019, and the number of U.S. babies acquiring HIV perinatally reduced from 74 in 2010 to 32 in 2019.[3] These decreases equate to a perinatal HIV diagnosis rate decline of 1.9 to 0.9 per 100 000 live births and a perinatal HIV transmission rate decline from 1.6% to 0.9%.[3] For this time period, the CDC's two-pronged goal of the perinatal HIV elimination benchmark has been successfully reached. 

Although this is excellent news, the outcomes are not experienced among all demographics equitably. There are still disparities in racial and ethnic minority communities. Transmission rates in 2019 among Hispanics, Latinos, and those identifying as ‘other’ were between 1% and 2%. Also, the odds of reproductive age people living with undiagnosed HIV are higher among Black and Hispanic individuals.[4] Success in the reduction of perinatal HIV is the result of coordinated intersecting efforts of scientists, medical practitioners, policymakers, community groups, and even drug companies. However, it is essential to continue researching why some groups are still not being reached. There are individual and systemic barriers that are still resulting in perinatal HIV disparities.

Photo Source: Illinois Department of Public Health

Change is paramount in continued treatment development for pregnant HIV-positive women as well. More research needs to be performed to develop safer and even more effective antiretroviral treatment that benefits the mother and infant. The World Health Organization, International Maternal and Pediatric, and Adolescent Clinical Trials, and the International AIDS Society recently published proposed recommendations to include women much earlier in the pipeline of development of drugs for HIV prevention and treatment.[5] Developing medicines that are increasingly safe during conception, pregnancy, and lactation is crucial.

Moreover, continued efforts to improve culturally relevant and unbiased support of diverse groups of women will further promote complete perinatal HIV eradication in the United States. Annually, around 3,000-4,000 HIV-positive women deliver babies. Motherhood should be encouraged for all who desire it, and HIV-positive women should be supported in their reproductive choices.

[1] U.S. Department of Health and Human Services. (2022, August 21). Global Statistics. Retrieved from https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics/

[2] National Institutes of Health. (2023, January 1). Preventing Perinatal Transmission of HIV. Retrieved from https://hivinfo.nih.gov/understanding-hiv/fact-sheets/preventing-perinatal-transmission-hiv#:~:text=What%20is%20perinatal%20transmission%20of,to%2Dchild%20transmission%20of%20HIV

[3] Lampe, M., Nesheim, S., Oladapo, K>, Ewing, A., Wiener, J., Kourtis, A. (2023, April 18). Achieving elimination of perinatal HIV in the United States. Retrieved from https://publications.aap.org/pediatrics/article-abstract/doi/10.1542/peds.2022-059604/191071/Achieving-Elimination-of-Perinatal-HIV-in-the?redirectedFrom=fulltext. https://doi.org/10.1542/peds.2022-059604

[4] Centers for Disease Control and Prevention. HIV Surveillance Supplemental Report 2021. Estimated HIV Incidence and Prevalence in the United States, 2015–2019. Vol. 26. Atlanta, GA: Centers for Disease Control and Prevention; 2021

[5] Penazzato M, Lockman S, Colbers A, et al. Accelerating investigation of new HIV drugs in pregnancy: advancing the research agenda from theory to action. J Int AIDS Soc. 2022;25 Suppl 2(Suppl 2): e25912   

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.