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Faces of AIDS

Illinois Perinatal HIV Prevention Policy

December 3, 2007 - Anne Statton of the Pediatric AIDS Chicago Prevention Initiative and colleagues presented at the 2007 CDC National HIV Prevention Conference on Illinois' pathbreaking perinatal HIV prevention programs. View the presentation here.

A new fact sheet is available that summarizes the Illinois Perinatal HIV Prevention Act (Public Law 95-702), including changes that will be effective June 1, 2008.

Background

June 2007 - During the early 1990s, before perinatal preventive treatments were available, an estimated 1,000-2,000 infants were born HIV-positive each year in the United States. In the last decade, the United States has seen dramatic reductions in mother-to-child, or perinatal, HIV transmission rates.

The medical community has developed treatments that effectively prevent mothers who are HIV-positive or living with AIDS from transmitting HIV to their newborns. Education and prenatal care are imperative to ensure that expectant mothers take advantage of these medical advances. According to the U.S. Centers for Disease Control and Prevention (CDC), without treatment, there is a one in four chance that a woman will pass HIV along to her newborn. With treatment, that risk can be reduced to two in 100.

Illinois is known throughout the United States for innovative strategies to prevent mother-to-child HIV transmission. Thanks to aggressive investments by the Illinois Department of Public Health (IDPH), foundations, and private donors, Illinois trains healthcare providers on effective interventions to prevent perinatal HIV transmission, provides intensive case management for pregnant, HIV-positive women, and operates other programs to help HIV-positive pregnant women have healthy pregnancies and HIV-free babies.

Over 7,000 women are reported as living with HIV/AIDS in Illinois. However, there likely to be an additional 2,600 Illinois women who do not know they are infected with the virus, based on AIDS Foundation of Chicago and national estimates. Women who do not know their status cannot access medications to reduce the likelihood of passing HIV along to their newborns. Universal HIV testing of pregnant women is needed to target HIV testing to this population of women who are HIV-positive but do not know it.

Thanks to anti-HIV medications, HIV-positive women are living longer. Like many women, they share the dream of raising healthy children who can live free of HIV. Expert medical treatment and supportive services can help HIV-positive women realize that dream.

The following timeline highlights some of the most important recent developments and changes in perinatal HIV prevention legislation in Illinois.

Timeline

2003
Illinois enacted the Perinatal HIV Prevention Law. The law required all healthcare providers treating pregnant women to offer voluntary HIV testing as early as possible in pregnancy. Rapid HIV testing was also required to be offered at labor and delivery to women whose HIV status was unknown.

2005
State Rep. Mary Flowers convened the Illinois House Healthcare Availability and Access Committee for hearings on the implementation of the 2003 law. AFC and PRTII testified.

2006
In 2006, State Rep. Mary Flowers (D-Chicago) and Children’s Memorial Hospital proposed H.B. 4306, which mandated HIV testing for newborns if the mother’s HIV status was unknown. AFC opposed the legislation because it denied mothers the ability to make decisions about their health care. AFC developed a fact sheet on H.B. 4306, AIDS Legal Council of Chicago issued a letter opposing mandatory newborn testing, and Drs. Patricia Garcia and Ann Bryant of Northwestern University Feinberg School of Medicine provided expert testimony.

However, when it became clear that the bill was likely to pass the General Assembly unopposed, AFC and partners (notably Pediatric AIDS Chicago Prevention Initiative (PACPI), ACLU of Illinois, and AIDS Legal Council of Chicago) negotiated improvements to the bill.

The final 2006 perinatal law required HIV testing of newborns whose mother’s HIV status is unknown. All hospitals must call the 24-hour perinatal HIV hotline to report women and newborns identified as preliminarily HIV-positive so they can be linked to case management. The new law also mandated monthly and annual reporting on rapid HIV tests conducted on pregnant women and newborns, and required the Illinois Department of Public Health to offer case management services to HIV-positive new mothers.

Also in 2006, IDPH finalized rules for the 2003 law. Ironically, they were out of date a few months later when Governor Rod Blagojevich signed the 2006 changes into law.

2007
In September of 2006, the U.S. Centers for Disease Control and Prevention released guidelines calling for opt-out HIV testing for pregnant women. Under opt-out testing, women are informed that that they will be tested for HIV unless they refuse.

Rep. Flowers once again introduced legislation during the 2007 General Assembly session to modify the perinatal HIV prevention law. HB 1759, which passed the House and Senate unanimously and was signed into law as Public Law 95-702, requires providers to institute opt-out HIV testing for all pregnant women. Women must be informed that they have the right to decline testing, and how to decline, but they must also be told that their newborn will be tested for HIV if they refuse. The law also mandates that hospitals report all HIV-exposed newborns in order for the state to obtain better data on the number of HIV-positive mothers giving birth in the state every year. A fact sheet summarizes the bill.