The following is a letter from the Philadelphia Department of Public Health regarding women and HIV/AIDs.
(Originally released on March 10, 2017)
Today, March 10th, is National Women and Girls HIV/ AIDS Awareness Day. Approximately 25% of all persons living in Philadelphia diagnosed with HIV are female. HIV continues to disproportionately affect Black and Latina women who represent 77% of those women living with HIV. The Philadelphia Department of Public Health (PDPH) reminds clinicians to routinely screen all women ages 13-64 years for HIV, and to screen women for HIV during each pregnancy to prevent vertical transmission of HIV.
Between 2011 and 2015, there were a total of 315 perinatal exposures, resulting in the birth of 5 HIV-infected infants in the City of Philadelphia.(1) The incidence of perinatal HIV transmission in Philadelphia has remained low over the past five years due to local perinatal prevention efforts.
All pregnant women should be screened for HIV infection in her first trimester or at entry into prenatal care. Women should be rescreened for HIV infection in the third trimester. If no screening was completed in the third trimester, an HIV rapid point-of-care test should be conducted during labor and delivery. Clinicians should use blood-based HIV-1/2 antigen/antibody combination immunoassay (4th generation) to screen for HIV infection(2). If antibody or antigen is positive, refer patients for immediate initiation of antiretroviral therapy (ART). For additional information or support, contact the Action Wellness 24/7 Perinatal Case Management Referral Line at 215-981-0088 or the AIDS Activities Coordinating Office Client Services Unit at 215-985-2437.
Report all cases of HIV infection in pregnant women to the PDPH within 1 business day. All cases of HIV infection should be reported to PDPH by calling (215) 685-4786. Additional reporting information is available at: https://hip.phila.gov/ReportDisease/HowToReport.
Women at continued risk for HIV exposure who are seeking pregnancy can be initiated on HIV pre-exposure prophylaxis (PrEP). PrEP is a bio-behavioral once daily medication (emtricitabine 300mg/ tenofovir disoproxil fumarate 200mg). PrEP can be taken prior to conception, during a pregnancy, and following delivery should a woman choose to breast feed to prevent HIV acquisition and mother-to-child transmission of HIV. Women who are sexually active may also benefit from conversations about including PrEP as part of their sexual risk reduction plans. Women with histories of multiple bacterial sexually transmitted infections (STIs), who are engaged in transactional sex, women who inject drugs, women who are the sex-partners of HIV positive individuals sex partners of HIV-infected persons, and MSM or heterosexual persons who themselves or whose sex partners have had more than one sex partner since their most recent HIV test may also benefit from PrEP as part of a comprehensive sexual health and risk reduction package.
For more information on perinatal HIV screening, please visit: http://nccc.ucsf.edu/clinical-resources/perinatal-resources/pregnancy. For more guidance on prescribing PrEP, please visit https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf
Kathleen A. Brady, MD
Medical Epidemiologist, AACO
(1) 2015 HIV/ AIDS in Philadelphia Surveillance Report. September 2016.
(2) US Centers for Disease Control, Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. September, 2006