Overview
Welcome to this issue of Preventing Perinatal HIV Transmission: Field Update. You are receiving this newsletter because you have attended one of HRET’s workshops on implementing rapid HIV testing, expressed an interest in perinatal HIV prevention in hospitals, or have signed up to receive it. This quarterly email newsletter connects its subscribers to news updates, trends, statistics, prevention programs, policy initiatives, tools, and useful practices relating to perinatal HIV prevention in U.S. hospitals. The Health Research & Educational Trust (HRET), with support from the Centers for Disease Control and Prevention (CDC), produces this newsletter as a forum for information dissemination and for communication among and between hospital staff, HIV experts, and researchers.

For more information on HRET’s Perinatal HIV Prevention project, please visit our Web site.

If you have comments or suggestions for future issues of this newsletter, please contact Cindy Greising at cgreising@aha.org.

Upcoming Events

Free Workshop on Eliminating Perinatal HIV Transmission in Columbus, Ohio

HRET and the CDC are hosting "Getting to Zero: How Hospitals Can Use Rapid Tests to Virtually Eliminate Mother-to-Child HIV Transmission" on Friday, November 20, 2009, at the Holiday Inn Worthington in Columbus, Ohio.

This free workshop includes presentations on the new Ohio laws related to HIV testing consent requirements and state maternity facility licensure changes. Other topics are the current state of perinatal HIV/AIDS, point-of-care vs. laboratory testing, overcoming barriers to training, culturally competent patient communication, prophylaxis and treatment, confirmatory testing, quality control, intrapartum care, referral and counseling, reporting requirements, and reimbursement. Presenters include CDC officials, HRET and AIDS Education and Training Centers staff, and local practitioners.

Open to hospital staff from labor and delivery, nursery, emergency, laboratory, infectious disease, and pharmacy, this workshop offers free continuing education credits. To register for the workshop, contact Barbara Mooney at bmooney@aha.org or (312) 422-2694.

Free Audioconference for Risk Managers on Eliminating Perinatal HIV Transmission

HRET and the American Society for Healthcare Risk Management (ASHRM) will host an audioconference, "Getting to Zero: Using Rapid Tests to Eliminate Mother-to-Child HIV Transmission," on Monday, November 16, 2009, at 2 p.m. ET, 1 p.m. CT, Noon MT, and 11 a.m. PT. Designed specifically for risk managers at hospitals and health care organizations, this 90-minute audioconference will provide information and address issues about rapid HIV testing in labor and delivery departments. Topics include the current state of HIV/AIDS, CDC and U.S. Preventive Services Task Force testing recommendations, state and local laws and reporting requirements, and cost. Scheduled speakers include Margaret Lampe, Division of HIV/AIDS Prevention, CDC, and Georgene Saliba, ASHRM president. A 20-minute question-and-answer session will conclude the audioconference.

To register for this audioconference, please contact Barbara Mooney at (312) 422-2694 or bmooney@aha.org.

CDC Hosts Web Series on HIV/AIDS in the African American Community

"A Call to Action for Leaders: The HIV/AIDS Crisis among African Americans" is a seven-part Web series that discusses strategies by African American leaders to address the impact of HIV/AIDS in their communities. Each part of the series is prerecorded and about 10 minutes in length. Click here for more information and links to online viewing.

Legislative Updates

Medicare Considers Proposal to Cover HIV Screening

The Centers for Medicare & Medicaid Services have proposed covering HIV screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and beneficiaries who request the screening. CMS is accepting public comments on the proposal through October 9, 2009, and expects to make a final decision by December 8, 2009. Click here for the news release.

Delaware Passes HIV Testing Bill

Delaware's State Senate passed a bill that would add HIV testing to the required tests administered to pregnant women. Women could "opt out" of taking the HIV test.

Ohio Changes HIV Testing Consent Requirements

The state of Ohio has passed legislation that allows a health care provider to order HIV testing when necessary for diagnosing or treating a patient, if the patient or a parent or guardian "has given consent to the provider for medical or other health care treatment." Patients have the right to request an anonymous test.

Tools from the Field

New Online Tool Maps U.S. HIV/AIDS Data

A National HIV/AIDS Atlas has been posted online by the National Minority Quality Forum (NMQF) to help track HIV/AIDS in the 50 states as well as Washington, D.C., Puerto Rico, and the U.S. Virgin Islands. The atlas presents county-level prevalence rates, and users can find HIV/AIDS statistics by age, gender, and race/ethnicity. The atlas was developed to allow "the public, health care professionals, policymakers, and elected officials to access and map local, state, and national data in order to see how HIV/AIDS is impacting their community." According to the NMQF, data from the atlas has been collected from the states and cross-checked with the CDC HIV/AIDS Surveillance Report.

Recent Research

Prechewing Food for Infants May Transmit HIV Virus

A recent report in Pediatrics documents three cases of HIV-infected caregivers who prechewed food for an infant and in turn transmitted the virus to the child. Researchers led by Aditya H. Gaur, MD, at St. Jude Children's Research Hospital in Memphis, examined the cases and eliminated other ways the infants might have contracted HIV. A previously unreported route of HIV transmission, premastication may account for some cases of "late" HIV transmission in infants that had instead been linked to breastfeeding. "Practice of Feeding Premasticated Food to Infants: A Potential Risk Factor for HIV Transmission" is published in the August 2009 issue of Pediatrics.

Many HIV-Infected Women Forego Pap Tests

A recent study indicates 23 percent of HIV-positive women in the United States have not had a Pap test in 12 months. The findings are from interviews of 2,400 women that were reviewed by Alexandra M. Oster, MD, and colleagues. The Pap test can detect early signs of cervical cancer, and HIV-infected women are at greater risk for cervical diseases and for abnormal Pap test results. Cervical cancer screening in HIV-infected women is particularly important because the risk of cancer has not decreased since highly active antiretroviral therapy has been introduced. "Prevalence of Cervical Cancer Screening of HIV-Infected Women in the United States" appears in the August issue of Journal of Acquired Immune Deficiency Syndromes.

CDC Report on Sexual Risk Behavior and AIDS in Adolescents and Young Adults

The CDC's Workgroup on Adolescent Sexual and Reproductive Health released a report indicating that many adolescents and young adults in the United States "engage in sexual risk behavior and have negative reproductive health outcomes." Among the findings are that "the annual rate of AIDS diagnoses reported among males aged 15-19 years has nearly doubled in the past 10 years," from 1.3 cases per 100,000 in 1997 to 2.5 cases in 2006. Examining the sexual behavior of young people aged 10 through 24, the report states that "although the majority of negative outcomes have been declining for the past decade, the most recent data suggest that progress might be slowing, and certain negative sexual health outcomes are increasing." Findings also show that new HIV and AIDS diagnoses were highest about young blacks for all age groups.

Study Identifies Gender Differences in HIV Response and Progression

HIV infection progresses more quickly in women than in men in the later stages of the disease, and researchers have identified a receptor molecule that may explain why. Findings are published in the July issue of Nature Medicine by the research team from the Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University. These findings may lead to new approaches in treating HIV.

First National HIV Prevention Inventory Is Published

Based on a survey of state health departments, The National HIV Prevention Inventory: The State of HIV Prevention across the United States provides the first, comprehensive inventory of HIV prevention efforts at the state and local levels. Released by the National Alliance of State and Territorial AIDS Directors and the Kaiser Family Foundation, the inventory offers a "baseline picture of how HIV prevention is delivered across the United States."

Overall HIV-Related Deaths Drop in 2007...

A report released in August by the CDC announces that the HIV-related death rate for U.S. residents has decreased 10 percent, the biggest one-year drop since 1998. HIV is the sixth leading cause of death among people aged 25 to 44. Overall, U.S. life expectancy has risen to 78 years, a new high.

...But Many U.S. Residents Are Diagnosed with HIV Late in Illness

Data from 1996 to 2005 show that about 45 percent of U.S. residents had developed AIDS within three years of their initial HIV diagnosis, with more than 38 percent developing AIDS within one year of the diagnosis and an additional 6.7 percent within the next two years. This CDC report highlights the concern that HIV-infected people unaware of their status may unknowingly transmit HIV to others and also do not receive medical care and treatment earlier when it is most beneficial.

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