Foster parents often wonder about the possibility that an infant placed in their care may be carrying an infectious disease, especially HIV. Fortunately progress has been made in reducing the transmission of HIV from mother to child so the likelihood of the placement of an infant infected with HIV is quite low.

There are many explanations for the decrease in incidence of HIV positive infants. Improved maternal health has significantly contributed to this decrease. There is no “cure” for HIV. However, new medications are available to treat those infected with HIV. These medications can help HIV positive people live long, healthy lives. Most medications to treat HIV are safe for pregnant women to take after the first trimester of pregnancy. Some of the HIV medications, in particular, Retrovir (also called AZT), reduce the risk of HIV transmission during pregnancy and birth. This is very good news. Thus, improved identification of HIV positive pregnant women will lead to improved treatment and decreased transmission of HIV.

Public health experts in the U.S. currently recommend HIV testing during pregnancy. Fortunately, Connecticut has been a forerunner in testing pregnant women. Testing has been mandatory since October, 1998. Doctors currently offer HIV testing one or more times during pregnancy. Women maintain the right to refuse. However, this will lead to testing of their newborn. Almost all women agree to the test.

Although doctors and nurses know that treatment is effective in preventing the baby from becoming infected with HIV, they cannot know if the baby is infected as soon as the baby is born. Special testing is required. Babies born to HIV infected mothers are referred to pediatric HIV specialists. In Connecticut, these specialists are located in the hospitals such as Connecticut Children’s Medical Center, Yale New Haven Hospital, Bridgeport Hospital and Stamford Hospital.

The infants are tested for HIV in the first 12 hours of life. The test is DNA testing for HIV. The HIV antibody test that older children and adults have, would not give accurate results for an infant. The DNA test for HIV is done again between 2 weeks and 1 month of age, at 2 months of age and again between 4 and 6 months of age. If any of these tests are positive, a confirmatory test is done right away. There are some differences in the testing schedules at the different hospitals. For example some of the specialists see the babies again when they are 12 months to 18 months. In all cases, pediatric specialists use national guidelines when testing and treating the infants.

What does this mean for a foster parent? Most women with HIV are healthy and able to care for their own children, but unfortunately there are some situations where infants will need to be placed in foster homes. If you accept the placement of an HIV exposed infant, you will be asked to follow through with the testing schedule described above. As an additional precaution against the transmission of HIV, the infant will be given a prescription for liquid Retrovir for the first six weeks of life. The infant may also be given a prescription for an additional medication, Bactrim (a medication given to prevent a specific type of pneumonia that people with HIV can get) for an additional 6 weeks.

What all of this testing and treatment has meant for infants born to HIV infected mothers in Connecticut is this: in 1999, there were 70 HIV pregnant positive women who delivered infants. Five of these infants were born with HIV infection. Since the law went into effect, there has been a total of 227 HIV infected pregnant women and there have only been 4 infants infected with HIV. This is very good news.

This article was originally published in the April 2004 issue of Communiqué, a resource for the Connecticut foster, adoptive and kinship care community.