The large decrease over time in mother-to-child HIV infection in the United States is a major public health success story. However, children in the United States are still being born with HIV, and infections among women are increasing. Today, women account for more than one quarter of new cases, compared to less than 10% in 1985.

The main challenge to preventing mother-to-child HIV transmission remains the fact that too many women don’t know they are HIV positive and they are not being routinely tested when pregnant. At the same time, many women aren’t aware that the right treatment can reduce the risk of passing the virus to their babies.

Other important challenges include:

Sexual Contact with HIV-infected Men

The risk factors for women have changed. Earlier in the epidemic, more women were exposed to HIV through injection drug use. During the 1990s, women were increasingly likely to become infected through sexual contact with HIV-infected men. This is why women should know their own -- and their partners’ -- HIV status and risk factors.

Lack of Prenatal Care

Women at highest risk for HIV often don’t get prenatal care or don’t have access to ongoing care during their pregnancy. These women are more likely to enter the delivery room not knowing their HIV status, and have not taken the antiretroviral drugs that can treat their own disease and reduce the risk of transmitting to their infant.

Problems with Getting Tested for HIV

Although, most HIV-infected women know they are infected before they give birth, testing rates remain uneven throughout the United States. For example, one study found that 18% of pregnant women were not tested until after childbirth.

Problems with Treatment

Many HIV-infected women and their infants still do not receive the correct drugs and other treatment or do not take the drugs properly. They may not get treatment or medical care. They may not live close to an HIV specialist who can make sure they receive proper treatment and care. Or they simply don’t have the information and resources to make decisions about their future.