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There is an elevated incidence of HIV and AIDS among women 15 to 45 years of age in New Jersey. Given the fact that perinatal transmission of HIV is the most common route of HIV infection in children and is the source of almost all cases of AIDS in children in the U.S., New Jersey has taken action to make sure that HIV testing is part of routine prenatal care.

On December 6, 2007, New Jersey passed an amendment to its 1995 legislation calling for more specific HIV testing requirements for pregnant women.

The Specifics

This amendment requires that HIV testing be part of routine prenatal care unless a woman declines it. The law specifies that education about HIV testing must be given in person, in writing, or with other materials, such as brochures or pamphlets. In addition, testing must be done as early as possible during the pregnancy and again in the third trimester.

Women who arrive at a facility in labor and have not been tested for HIV during the pregnancy must be informed that they will have HIV testing unless they refuse. All infants born to mothers with unknown HIV status will be tested unless the mother gives written objection based on religious beliefs.

Some History

According to the original state law of 1995, health professionals were required to counsel pregnant women and offer HIV testing; consent for HIV testing was obtained by the healthcare provider. This legislation to help reduce perinatal transmission of HIV was enacted after the results of AIDS Clinical Trial Group Protocol 076 were announced.

However, in 2005, 68 more infants were infected, leading to further investigations — and thus, the amendment was proposed and passed in 2007 (Section 1 of P.L.1995, c.174 [C.26:5C-15]).

Steps Forward

The rate of perinatal transmission of HIV is less than 2% when antiretroviral therapy is given to the mother antepartum and intrapartum, and to the infant after birth, according to Maternal and Child Health Journal. The amendment may close a gap in HIV prevention that currently exists. Women who arrive in labor and delivery with unknown HIV status will have a rapid HIV test, and infants will have a rapid HIV testing if the maternal HIV status is unknown.

More research will be necessary to determine what more can and must be done. Recent data must be analyzed to determine whether the rate of perinatal transmission has decreased in N.J. Some questions are:

Did the law help to decrease the rate of this disease?

How does New Jersey compare to other states that have not addressed this issue in the same way?

What other interventions may augment N.J.'s program?

Will they further decrease perinatal transmission?

Challenges Present and Future

Nurses must educate women about prevention and testing, but they must also explain the necessity of retesting, since exposure may have been too recent to give an accurate testing result. When a woman tests negative for HIV at eight weeks' gestation, it does not mean that both she and her baby have not been exposed to HIV — or that she will remain HIV-negative throughout her pregnancy.

The nurse needs to know the woman's HIV status during the third trimester, since 70% to 80% of perinatal HIV transmission occurs during the intrapartum period, according to the Journal of Perinatal and Neonatal Nursing. Pregnant women who are HIV-positive should come to the hospital during labor rather than waiting until delivery is imminent; the CDC recommends that these women receive a loading dose of Zidovudine (ZVD), followed by a maintenance dose during labor.

Although pregnant black women have been affected by HIV more than other groups, they are less likely to report ever being tested for HIV, according to AIDS Care. The MCN reported that most black and Latino women who are newly diagnosed with HIV have been infected by male partners and many were unaware that their partners were HIV-positive. Poverty, lack of health insurance, and social isolation are some issues that contribute to the disparity in HIV among black and Latino women.

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Donna Weeks, RN, APN, C, is a perinatal clinical specialist at Saint Peter's University Hospital in New Brunswick, N.J. To comment, e-mail editorNJ@nursingspectrum.com.