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Book Forum: Infant and Child Development   |    
Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States
RUSSELL EISENMAN, PH.D.
Am J Psychiatry 2001;158:151-152. doi:10.1176/appi.ajp.158.1.151
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Edited by Michael A. Stoto, Donna A. Almario, and Marie C. McCormick, Committee on Perinatal Transmission of HIV, Division of Health Promotion and Disease Prevention, Institute of Medicine, and Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education, National Research Council and Institute of Medicine. Washington, D.C., National Academy Press, 1999, 397 pp., $39.95.

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People are often aware of intravenous drug use and sexual intercourse as two major ways that the HIV/AIDS virus is transmitted. What about the HIV-positive mother transmitting it to her child at birth? This is not considered as much as it should be. This book deals with a wealth of knowledge about such issues. "Perinatal" is an important term—strangely not defined in the book’s glossary—referring to things happening around the time of birth. It includes what happens before, during, and shortly after birth. The mother’s health and the prenatal care—or lack of it—that she receives can influence what happens to her newborn child. If the mother has acquired the AIDS virus, she can transmit it to her baby. Among the many gems in this book is the report that the antiretroviral drug zidovudine, if administered during pregnancy and childbirth, would reduce by two-thirds the chance of the child of an HIV-positive mother being infected with HIV.

The book has an executive summary, followed by seven chapters: "Introduction," "Public Health Screening Programs," "Descriptive Epidemiology of the Perinatal Transmission of HIV," "Natural History, Detection, and Treatment of HIV Infection in Pregnant Women and Newborns," "Context of Services for Women and Children Affected by HIV/AIDS," "Implementation and Impact of the Public Health Service Counseling and Testing Guidelines," and "Recommendations." Following the chapters are 15 appendixes containing diverse information, including summaries of site visits to several states.

Only a few of the many interesting findings can be mentioned here. These include the disproportionate amount of HIV infection in Hispanic and African American women and in women living in poverty; the reluctance many women have to tell their boyfriends or husbands about being HIV positive, fearing violence as the reaction; the need, according to some authors, for routine testing of pregnant women for HIV and always informing them of the results; the fact that sexually transmitted diseases may increase the likelihood of perinatal HIV transmission; the association between maternal vitamin A deficiency and some kinds of HIV transmissions to the baby; managed care regulations or practices that deny proper treatment for women with HIV; and changes in welfare laws that may make women unable to obtain or be unaware of services that could help them avoid perinatal transmission of HIV.

This book performs a major service by providing up-to-date information about the HIV/AIDS crisis. It is based on work done by people who are in the field trying to make things better, or in the research laboratory trying to understand what is occurring. Thus, it contains insights from people who know the HIV/AIDS field very well and who can provide the latest information. It is highly recommended, especially for those concerned with perinatal transmission of HIV/AIDS.

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