HIV and Pregnant Women, Infants, and Children

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HIV can be passed from mother-to-child anytime during pregnancy, childbirth, and breastfeeding. This is called perinatal transmission.

graphic of a bottle of pills

If you are pregnant or planning to get pregnant, get tested for HIV as soon as possible. If you have HIV, the sooner you start treatment the better—for your health and your baby’s health and to prevent transmitting HIV to your sex partner. If you don’t have HIV, but your partner does, ask your doctor about medicine to prevent getting HIV, called pre-exposure prophylaxis (PrEP).

Preventing Perinatal HIV Transmission

Advances in HIV research, prevention, and treatment have made it possible for many women with HIV to give birth to babies who are free of HIV. The annual number of HIV infections through perinatal transmission in the United States and dependent areasa has declined by more than 95% since the early 1990s.

What you can do if you are pregnant and have HIV. The first icon is yellow with an image of a health care worker. The text next to it reads visit your health care provider regularly. The second icon is blue with an image of pills. The text next to it reads take HIV medicine as prescribed to stay healthy, protect your partner, and protect your baby. Taking HIV medicine reduces the amount of HIV in the body (viral load) to a very low level, called viral suppression or an undetectable viral load. Getting and keeping an undetectable viral load is the best thing you can do to stay healthy and help prevent transmission to your baby. The third icon is teal with an image of 1 percent. The text next to it reads the risk of transmitting HIV to your baby can be 1 percent or less if you: take HIV medicine daily as prescribed throughout pregnancy, labor and delivery. Give HIV medicine to your baby for 4-6 weeks after giving birth. The fourth icon is red with an image of a pregnant woman. The text next to it reads if your viral load is not adequately reduced, a Cesarean delivery can also help prevent HIV transmission. The fifth icon is purple with an image of a baby bottle. The text next to it reads do not breastfeed or pre-chew your baby’s food. Keeping an undetectable viral load substantially reduces, but does not eliminate, the risk of transmitting HIV through breastfeeding. The current recommendation in the U.S. is that mothers with HIV should not breastfeed their babies.

*Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood. An undetectable viral load means having a viral load so low that a test can’t detect it. The benefits of having an undetectable viral load also apply to people who stay virally suppressed.

All women who are pregnant or trying to get pregnant should encourage their partners to also get tested for HIV. If either partner has HIV, that partner should take HIV medicine daily as prescribed to stay healthy and prevent transmission.

graphic of a bottle of pills

Taking HIV medicine every day can make the viral load undetectable. People who get and keep an undetectable viral load (or stay virally suppressed) have effectively no risk of transmitting HIV to HIV-negative sex partners.

For babies with HIV, starting treatment early is important because the disease can progress quickly in children. Providing HIV medicine early can help children with HIV live longer, healthier lives.

The Numbers

Perinatal HIV Transmission

We don’t know exactly how many women with HIV give birth annually in the United States. Recent evidenceexternal icon suggests that the number is less than 5,000.

Of the 37,968 new HIV diagnoses in the US and dependent areas in 2018, less than 1 percent (65) were due to perinatal transmission.

Diagnoses of Perinatal HIV Infections in the US and Dependent Areas by Race/Ethnicity, 2018*

Most perinatal HIV diagnoses were among Black/African American children.

This chart represents Diagnoses of Perinatal HIV Infections in the US and Dependent Areas by Race/Ethnicity, 2018. Black/African American equals 65 percent (42), White equals 14 percent (9), Hispanic/Latino equals 9 percent (6), multiple races equals 8 percent (5), Asian equals 5 percent (3).

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* In 2018, there were no cases of perinatal HIV among Native Hawaiians/Other Pacific Islanders and American Indians/Alaska Natives.
† Children under the age of 13.
‡ Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for Americans of African descent with ancestry in North America.
** Hispanics/Latinos can be of any race.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated). HIV Surveillance Report 2020;31.

Diagnoses of Perinatal HIV Infections in the US and Dependent Areas, 2014-2018

This chart shows diagnoses of perinatal HIV infections in the US and dependent areas from 2014 to 2018. HIV diagnoses declined 54 percent among children overall from 2014 to 2018. 2014 equals 141, 2015 equals 110, 2016 equals 103, 2017 equals 88, 2018 equals 65.

Rates of Perinatally-Acquired HIV Infections Among Persons Born in the United States, by Year of Birth and Mother’s Race/Ethnicity, 2014-2018 *†‡

This chart shows rates of perinatally-acquired HIV infections among persons born in the United States, by year of birth and mother’s race/ethnicity from 2014 to 2018. 2014: Black equals 5.4, Hispanic equals 0.7, White equals 0.2, 2015: Black equals 5.9, Hispanic equals 0.9, White equals 0.4, 2016: Black equals 5.0, Hispanic equals 1.1 White equals 0.1, 2017: Black equals 4.5, Hispanic equals 0.6, White equals 0.2, 2018: Black equals 3.3, Hispanic equals 0.5, White equals 0.4.
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*Data include only persons born in the United States (50 states and District of Columbia). Data accounted for delays between birth and diagnosis, as well as between diagnosis and reporting.
†Rates are per 100,000 live births.
‡Live-birth data reflect race/ethnicity of the infant’s mother.
**Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for Americans of African descent with ancestry in North America.
††Hispanics/Latinos can be of any race.
Source: Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2018. pdf icon[PDF – 4 MB] HIV Surveillance Supplemental Report 2020;25(2)

Living With HIV

This banner reads of the 1,042,270 people with diagnosed HIV at the end of 2018, less than 1 percent (1,544) were among children with diagnosed perinatal HIV.

Total Number of Children With Diagnosed Perinatal HIV in the US and Dependent Areas, 2018*

Most children with diagnosed perinatal HIV are Black/African American.

This chart represents the total number of number of children with diagnosed perinatal HIV in the US and dependent areas, 2018. Black/African American equals 60 percent (934), Hispanic/Latino equals 14 percent (223), White equals 11 percent (172), multiple races equals 9 percent (133), Asian equals 5 percent (72), American Indian/Alaska Native equals less than 1 percent (7), Native Hawaiian/Other Pacific Islander equals less than 1 percent (3).

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*Children under the age of 13.
†Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for Americans of African descent with ancestry in North America.
‡Hispanics/Latinos can be of any race.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated). HIV Surveillance Report 2020;31.

Total Number of Adults and Adolescents With Diagnosed Perinatal HIV in the US and Dependent Areas, 2018*

Most adults and adolescents with diagnosed perinatal HIV were Black/African American.

This chart shows the total number of adults and adolescents with diagnosed perinatal HIV in the US and dependent areas, 2018. Black/African American equals 57 percent (6,130), Hispanic/Latino equals 25 percent (2,710), White equals 11 percent (1,169), multiple races equals 6 percent (626), Asian equals 1 percent (101), American Indian/Alaska Native equals less than 1 percent (13), Native Hawaiian/Other Pacific Islander equals less than 1 percent (3).

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*Adults and adolescents who got HIV as infants through perinatal transmission.
†Black refers to people having origins in any of the Black racial groups of Africa. African American is a term often used for Americans of African descent with ancestry in North America.
‡ Hispanics/Latinos can be of any race.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated). HIV Surveillance Report 2020;31.

Prevention Challenges

icon of doctor bag

Pregnant women with HIV may not know they have the virus. CDC recommends HIV testing for all women as part of routine prenatal care. According to CDC research, more women take the prenatal HIV test if the opt-out approach is used. Opt-out prenatal HIV testing means that a pregnant woman is told she will be given an HIV test as part of routine prenatal care unless she opts out—that is, chooses not to have the test. In some parts of the country where HIV among women is more common, CDC recommends a second test during the third trimester of pregnancy.

icon of a hand holding a pregnancy test

Women with HIV may not know they are pregnant, how to prevent or safely plan a pregnancy, or what they can do to keep their baby from getting HIV.

icon of a bottle of pills

To get the full protective benefit of HIV medicine, the mother needs to take it as prescribed—without interruption—throughout pregnancy and childbirth and provide HIV medicine to her infant. Pregnant women with HIV may have nausea during pregnancy that can interfere with taking medicines, and new mothers may not be able to see their HIV medical care provider consistently.

icon of a woman sitting in a doctor's office

Social and economic factors, especially poverty, affect access to health care, and disproportionately affect people with HIV. Pregnant women with HIV may face more barriers to accessing medical care and staying on treatment if they also inject drugs, use other substances, are experiencing homelessness, or are incarcerated, mentally ill, or uninsured.

What CDC Is Doing

  • Under the integrated HIV surveillance and prevention cooperative agreement, CDC awards around $400 million per year to health departments for HIV data collection and prevention efforts. This award directs resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the US.
  • In 2019, CDC awarded $12 million to support the development of state and local Ending the HIV Epidemic plans in 57 of the nation’s priority areas. To further enhance capacity building efforts, CDC uses HIV prevention resources to fund the National Alliance of State and Territorial AIDS Directors (NASTAD) with $1.5 million per year to support strategic partnerships, community engagement, peer-to-peer technical assistance, and planning efforts.
  • In 2020, CDC will award around $109 million per year to support the implementation of state and local Ending the HIV Epidemic plans with a five-year funding program.
  • Under the flagship community-based organization cooperative agreement, CDC awards about $42 million per year to community organizations. This award directs resources to support the delivery of effective HIV prevention strategies to key populations.
  • In 2019, CDC awarded a cooperative agreement to strengthen the capacity and improve the performance of the nation’s HIV prevention workforce. New elements include dedicated providers for web-based and classroom-based national training, and technical assistance tailored within four geographic regions.
  • CDC has developed a framework external iconto guide federal agencies and other organizations in their efforts to reduce the rate of perinatal transmission of HIV to less than 1% among infants born to women with HIV and less than 1 perinatal transmission per 100,000 live births. These are the goals that CDC has developed for elimination of mother-to-child HIV transmission in the United States.
  • CDC supports CityMatCH to convene a group of stakeholders including public health professionals and clinical care providers to implement the CDC framework.
  • CDC funds perinatal HIV prevention through the Integrated Human Immunodeficiency Virus Surveillance and Prevention Programs for Health Departments. Key partner activities include promoting HIV testing and ART for pregnant women; an HIV surveillance and birth registry match to identify mother-infant pairs in need of services; perinatal HIV exposure surveillance; and a community-based quality improvement process using case reviews, that is, the FIMR-HIV methodologyexternal icon, and perinatal HIV services coordination.
  • Through its Let’s Stop HIV Together campaign, CDC offers resources about HIV stigma, testing, prevention, and treatment and care. This campaign is part of the Ending the HIV Epidemic initiative.

aAmerican Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.

Additional Resources

Web Sites

General Resources

  1. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated). HIV Surveillance Report 2020;31.
  2. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2018. pdf icon[PDF – 4 MB] HIV Surveillance Supplemental Report 2020;25(2).
  3. Nesheim SR, FitzHarris LF, Lampe MA, et al. Reconsidering the number of women with HIV infection who give birth annually in the United States. Public Health Rep 2018;133(6):637-43. PubMed abstract external icon.
  4. Little KM, Taylor AW, Borkowf CB, et al. Perinatal antiretroviral exposure and prevented mother-to-child HIV infections in the era of antiretroviral prophylaxis in the United States, 1994-2010external icon. Pediatr Infect Dis J 2017;36(1):66-71.
  5. Clinical Guidelinesexternal icon. 2020.
  6. CDC. Pediatric HIV surveillance (through 2018) ppt icon[slides]. Accessed June 18, 2020.
  7. Townsend CL, Cortina-Borja M, Peckham CS, et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS 2008;22(8):973-81. Pubmed abstractexternal icon.
  8. CDC. Achievements in public health: reduction in perinatal transmission of HIV infection—United States, 1985–2005. MMWR 2006;55(21):592-7.
  9. Fleming PL, Lindegren ML, Byers R, et al. Estimated number of perinatal HIV infections, U.S., 2000. Poster presented at: XIV International AIDS Conference; July 7-12, 2002; Barcelona, Italy.
  10. Whitmore SK, Zhang X, Taylor AW, et al. Estimated number of infants born to HIV-infected women in the United States and five dependent areas, 2006. J Acquir Immune Defic Syndr 2011;57(3):218-22. Pubmed abstractexternal icon.
  11. Valverde E, Short W, Brady K, et al. HIV medical provider’s assessment of the reproductive plans of women receiving HIV care: medical monitoring project provider survey, 2009. Paper presented at: 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 17-20, 2011; Rome, Italy.
  12. Whitmore SW, Taylor AW, Espinoza L, et al. Correlates of mother-to-child HIV transmission in the United States and Puerto Rico. external icon Pediatrics 2012;129(1):74-81.
  13. Taylor AW, Nesheim S, Whitmore S, et al. Estimated number and characteristics associated with perinatal HIV infections, 33 states, United States, 2003–2007. Paper presented at: 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011; Rome, Italy.
  14. Branson B, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(RR-14):1-17.
  15. Barrow RY, Newman LM, Douglas JM Jr. Taking positive steps to address STD disparities for African American communitiesexternal icon. Sex Transm Dis 2008;35(12 Suppl):S1-S3.
  16. Gaur AH, Dominguez KL, Kalish ML, et al. Practice of feeding premasticated food to infants: a potential risk factor for HIV transmissionexternal icon. Pediatrics 2009;124(2):658-66.
  17. Lampe MA, Smith DK, Anderson GJ, Edwards AE, Nesheim SR. Achieving safe conception in HIV-discordant couples: the potential role of oral preexposure prophylaxis (PrEP) in the United Statesexternal icon. Am J Obstet Gynecol 2011;204(6):488.e1-8.
  18. Luzuriaga K, Tabak B, Garber M, et al. HIV type 1 (HIV-1) proviral reservoirs decay continuously under sustained virologic control in HIV-1–infected children who received early treatmentexternal icon. J Infect Dis 2014;210(10);1529-38.
  19. Nesheim SR, Wiener J, FitzHarris L, et al. Brief report: estimated incidence of perinatally acquired HIV infection in the United States, 1978–2013external icon; J Acquir Immune Defic Syndr 2017;76:461-4.
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Page last reviewed: August 26, 2020
Content source: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention