According to information in the article, infection with HIV has increasingly occurred among women of childbearing age, with New York State (NYS) having the largest proportion of HIV-infected women and children in the United States. In November 1987, the NYS Department of Health began monitoring the HIV epidemic among childbearing women with the implementation of the Survey of Childbearing Women, in which blood specimens from all infants born in NYS were tested for HIV antibodies by the state Newborn Screening Program.
Wendy P. Pulver, M.S., of the New York State Department of Health, Albany, and colleagues assessed HIV prevalence trends among childbearing women in NYS from 1988 through 2000. A total of 3.43 million infants were tested for HIV antibodies during the 13-year period studied.
The researchers found that trends indicated a steady decline in HIV prevalence in NYS over the study period. New York City had a 49 percent decrease in prevalence from 1.22 percent between 1988 through 1989 to 0.62 percent in 1999 through 2000. The rest of NYS showed a 24 percent decline (from 0.17 percent to 0.13 percent). Analysis showed that some areas of the state experienced little or no decline.
"White and Hispanic women experienced the greatest declines in NYC (68 percent and 61 percent, respectively)," the researchers write. "African American women in NYC also experienced a decline in prevalence (31 percent) but not as great a decline as that seen in white and Hispanic women. Outside NYC, Hispanic and African American women (73 percent and 37 percent, respectively) also experienced declines, with white women showing the smallest decline (17 percent)."
The researchers discuss several factors that may contribute to the decline: the widespread use of highly active antiretroviral therapy; older women with HIV were likely dying prematurely or having difficulty conceiving or carrying an infant to term; and efforts aimed at minority populations were successful in affecting women in NYS.
"Throughout this period, significant declines in HIV prevalence have been observed in New York among childbearing women," the researchers write. "In addition, there have been dramatic decreases in the number of deaths due to AIDS in NYS. The availability of highly active antiretroviral therapy may lead some HIV-infected women to decide to become pregnant because of a more positive outlook for their own health and because, coupled with the use of zidovudine [an anti-HIV drug], the therapy reduces vertical transmission, resulting in a potential reversal of the observed downward trends in maternal HIV prevalence among childbearing women. Thus, the continued decrease in prevalence is even more remarkable because of this possibility that more women who know their HIV status may be electing to have children."
The researchers conclude: "These data will continue to be used to evaluate and target HIV prevention efforts and serve as an early warning of changes in populations at risk as the epidemic continues to evolve."
(Arch Pediatr Adolesc Med. 2004;158:443-448. Available post-embargo at archpediatrics.com) Editor's Note: Data collection for this study was initially partially supported with funding through cooperative agreements with the Centers for Disease Control and Prevention, Atlanta, Ga.
Editorial: Successes and Challenges in the Perinatal HIV-1 Epidemic in the United States as Illustrated by the HIV-1 Serosurvey of Childbearing Women
In an accompanying editorial by Lynne M. Mofenson, M.D., of the National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Md., writes that although HIV mother-to-child transmission (MTCT) rates have decreased in the United States over the past ten years, MTCT still occurs. Dr. Mofenson writes that "Whereas adolescent pregnancy rates have declined, adolescent pregnancy rates remain higher in the United States than in many other resource-rich countries, and they are particularly high among adolescents of minority race or ethnicity, the very group most at risk for HIV-1 infection. Thus, prevention of unwanted adolescent pregnancies is also an important component of preventing MTCT."
Of the study by Pulver and colleagues, Dr. Mofenson writes, "First, the study illustrates the focality of the HIV-1 epidemic; even within the high-risk area of New York City, there was a focus of higher HIV-1 prevalence in the Bronx. This is consistent with the concept of core subpopulations that create an interrelated high-risk transmission network for infection that has been reported for other sexually transmitted diseases."
"Second, the study demonstrates the disproportional impact of HIV-1 infection on women of minority race or ethnicity. Despite a general decline in HIV-1 [prevalence] among childbearing women in New York State in general, this decline was lowest in women of minority race or ethnicity, particularly in younger African American women in New York City for whom the rate of [prevalence] was stable or increased over time."
Dr. Mofenson concludes, "In summary, the New York State longitudinal [survey] of childbearing women is invaluable for understanding the HIV-1 epidemic in women and children in New York and for the development of targeted programs and new policies to intervene and prevent MTCT. It provides a model for the conduct of surveillance programs in other areas of the United States."
(Arch Pediatr Adolesc Med. 2004;158:422-425. Available post-embargo at archpediatrics.com)
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail firstname.lastname@example.org .
To contact Wendy P. Pulver, M.S., call the Office of Public Affairs for the New York State Health Department at 518/474-7354. To contact editorialist Lynne M. Mofenson, M.D., call Bob Bock at 301/496-5133.