When HIV testing policy fails: Reasons California women lack HIV testing during pregnancy

Background: National estimates indicate one in three pregnant women is not HIV tested despite testing mandates. Prenatal testing is highly associated with successfully preventing HIV transmission. This study looks at reasons pregnant women are not prenatally tested.

Methods: 10,976 women ≥15 yrs, were sampled from the population of all 500,000+ women delivering annually in California. Subjects were identified through birth certificate data (2003-2005), as part of Maternal and Infant Health Assessment; an English/Spanish population-based mailed survey (>70% response rate). Outcomes were reasons specified in the survey for not being prenatally HIV tested; women could choose more than one reason.

Results: Among women who reported not being tested (20.24%) the main reasons for lack of testing were: thought they did not have HIV (52.35%), were not offered a test (37.19%), and were previously tested (32.10%). From multivariate analysis Latina and Asian women were almost twice as likely as black women to not have the test offered. Married women were 1.8 times more likely to think they did not have HIV than unmarried women. College graduates were 1.6 times more likely to not get tested because they were previously tested compared with those with a high school education or less.

Conclusions: It is notable that over 35% of women reported lacking a prenatal HIV test because they were not offered one. A perceived lack of risk also appeared to be associated with decreased testing. These findings may inform interventions with specific groups to improve rates of HIV test offer in pregnancy.