Abstract
Dear Editor:
Despite dramatic reductions in perinatal transmission of HIV in the United States, barriers to prevention still exist and perinatal HIV infections continue. The work of Podhurst and colleagues 1 recently presented in this journal highlights ongoing barriers to the elimination of perinatal HIV; they focus on patients' opinions and knowledge about HIV testing during pregnancy. Disconcerting is that the women surveyed were recruited from clinics with high prevalences of HIV and specifically funded to provide specialized HIV services, testing, and education initiatives. One of three women surveyed felt there was not enough information about HIV and pregnancy; 20% of women did not know that HIV could be transmitted to their babies during pregnancy and 35% were unaware that transmission could occur during delivery. Nearly 40% of women did not realize there were medications available to prevent perinatal transmission, perhaps indicating another barrier to obtaining HIV testing. The good news is that women with more knowledge about perinatal HIV transmission reported acceptance of HIV testing during pregnancy. These findings highlight the need to develop and test campaigns that address knowledge barriers to HIV testing. While several strategies could address low HIV knowledge, media campaigns are a cost-effective and underutilized intervention.
Special attention is needed to increase African American and Hispanic women's knowledge of perinatal HIV prevention. Over two thirds of the Podhurst study population were African American or Hispanic and these women were more likely to have lower HIV knowledge than white women. In national surveys approximately 40% of African Americans and approximately 50% of Hispanics are unaware of medications to prevent perinatal HIV transmission, a knowledge deficit associated with acceptance of HIV testing. 2 –5 African American and Hispanic women make up 80% of HIV/AIDS cases among women and according to U.S. Centers for Disease Control and Prevention (CDC) data, at the end of 2007, 86% of perinatally infected children were African American or Hispanic. 6,7 Lack of timely HIV testing during pregnancy is a major contributor to this outcome. 8
Interventions are needed that will address knowledge barriers to HIV testing among African American and Hispanic women. Research has found that women who have information about methods to prevent perinatal HIV transmission and the importance of testing for the baby's or mother's health are more likely to be HIV-tested. 2,4,5 Media campaigns addressing the benefits of HIV testing may be a significant intervention. Media campaigns are not only successful in promoting HIV testing but, in populations with high HIV prevalence, they also are cost effective. 9,10 A national survey done in 2009 found that compared to other sources of information such as health professionals, family, and friends, African Americans and Hispanic cite the media as their leading source of HIV/AIDS information. 3 In this survey, 35% of African Americans and 46% of Hispanics reported not having seen, heard, or read a lot or some about the problem of HIV/AIDS in the past year, perhaps highlighting a reason for lower knowledge about HIV transmission and benefits of HIV testing during pregnancy. Additionally, 1 of 3 participants surveyed wanted to have more information about whether or not they should be tested for HIV.
Given the prominent role the media have as an HIV information source for African Americans and Hispanics, and its success and cost effectiveness for promoting HIV testing, it is encouraging that in 2009 the CDC launched a 5-year national media campaign—in English and Spanish—that emphasizes the importance of HIV testing. 11 Additionally, because of the crisis facing African American communities, the CDC has begun piloting separate campaigns with messages that promote HIV testing in African American communities. While addressing the benefits of HIV testing, these campaigns also will help address the stigma surrounding HIV testing, a potential barrier to HIV testing for 16% of the population in a recent survey. 3 Past media campaigns have targeted pregnant women. 12 However, to our knowledge there is no published research on the effectiveness of media campaigns in addressing knowledge gaps that may be impacting lowered uptake of HIV testing among pregnant African American and Hispanic women.
According to data from the CDC's Pediatric Spectrum of HIV Disease Project, addressing barriers to HIV testing among pregnant women may be one of the two most important interventions for interrupting continued perinatal HIV transmission in the United States. 8 Ongoing barriers to HIV testing certainly exist at the institutional level (e.g., state laws, medical care guidelines, health care institution policies) and health care provider level (e.g., knowledge and acceptance of HIV testing recommendations). The work of Podhurst emphasizes that patient-level barriers also need to be addressed to reach a goal of HIV testing for 100% of pregnancies. Because African American and Hispanic women have lower perinatal HIV transmission knowledge and have disproportionate rates of perinatal HIV transmission, a concerted focus should be on these women. Since the media are the most prominent source of HIV information for these women, media campaigns addressing the facts of perinatal HIV transmission and the importance of HIV testing during pregnancy should be developed and tested for effectiveness in increasing HIV testing. Based on the work of Podhurst and others, these interventions may be a critical step to ending continued perinatal HIV transmission in the United States.