HIV testing in a national sample of pregnant US women: who is not getting tested?

It is recommended that all pregnant women in the US receive an HIV test as early as possible during prenatal care to allow HIV-infected women to begin receiving anti-retroviral drugs when they most effectively prevent transmission. We analyzed interview data from a nationally-representative sample of pregnant women to examine the extent of HIV testing among pregnant women and the characteristics associated with testing, including access to healthcare. We used data from the combined 2001 and 2002 Behavioral Risk Factor Surveillance System, a nationally-representative telephone-based behavioral survey of adults, aggregated across all states to yield national estimates. Among 4,855 women pregnant at interview we looked at the percentages recently tested and never tested by major populations subgroups and assessed differences using chi-square tests and multiple logistic regression analysis. Pregnant women were tested at a much higher rate than other women of the same age - 54.1% had been tested in the past year compared with 15.4% of non-pregnant women. Categories of pregnant women that were more likely to never have been tested for HIV include those without a health plan or insurance (adjusted odds ratio (AOR): 1.6) and those without a personal doctor (AOR: 1.7). Women with knowledge of methods to prevent perinatal HIV transmission were less likely to have never been tested (AOR: 0.8). Attaining the recommended goal of universal prenatal testing will require attention to women without personal doctors or health insurance.