HIV Prevention for New Mothers: Knowledge, Attitudes, and Practices
"A Study on Puerperal Women's Understanding and Behaviors Regarding HIV Infection and Its Prevention."
The infection caused by the human immunodeficiency virus (HIV) and AIDS presents significant public health challenges globally. In Ceará, Brazil, and worldwide, these issues are increasingly prevalent, affecting both men and women. The epidemiological profile of HIV/AIDS has shifted over the past two decades, expanding beyond traditionally recognized risk groups to affect the general population, marked by heterosexualization, feminization, and increased prevalence among those with fewer resources.
Given that many women affected by HIV are of reproductive age, preventing vertical transmission—transmission from mother to child during pregnancy, labor, delivery, or breastfeeding—is particularly important. Effective preconception care is essential for determining a mother's HIV status, educating her, and providing necessary preventive care. This approach relies on the early identification of infected pregnant women.
Alongside preconception care, prenatal care is crucial for preventing virus transmission. Guidance and counseling before and after HIV testing are vital. These interventions require building trust, establishing open communication between healthcare providers and clients, using accessible language, maintaining confidentiality, and respecting individual differences. However, access to timely HIV testing for pregnant women remains a challenge, often resulting in delays or complete absence of testing. Therefore, providing information about HIV prevention and detection during the puerperal period is essential to prevent vertical transmission.
Measuring HIV Prevention Progress
The CDC's Ending the HIV Epidemic initiative uses six indicators to measure progress toward national 2025 and 2030 HIV prevention goals. These include estimated annual new HIV infections and the estimated percentage of people with HIV who have received a diagnosis. The WHO separately tracks the estimated percentage of pregnant women living with HIV who received antiretrovirals to prevent mother-to-child transmission. Together, these measures address both population-level prevention progress and access to prevention of perinatal transmission.
From Crisis to Prevention
HIV.gov's timeline follows the history of HIV and AIDS in the United States from the first reported cases in 1981 to the present. It describes a period in which people living with HIV can live long, healthy lives. A major perinatal milestone came in August 1994, when the U.S. Public Health Service recommended that pregnant women living with HIV be offered AZT. A 2024 review reports that annual perinatal HIV infections decreased by 97% since 1994 and that 22,732 infections were prevented in the United States from 1994 through 2020.
Key Findings: Knowledge Gaps and Attitudes Towards HIV
A cross-sectional study was conducted involving 278 women in a rooming-in maternity setting in Fortaleza, Ceará, Brazil, during November and December 2011. The study aimed to evaluate the knowledge, attitudes, and practices of puerperal women concerning HIV infection and its prevention. Data was collected through interviews using a structured questionnaire to assess these factors.
- Adequate Knowledge: Defined as mentioning having heard about HIV, reporting at least three forms of virus transmission, and at least three forms of prevention.
- Inadequate Knowledge: Defined as either never having heard of HIV or not being able to cite at least three appropriate ways of transmission and prevention.
- Inadequate Attitude: Characterized by recognizing that becoming HIV-infected is unlikely or expressing no opinion, disregarding the necessity of health services offering HIV testing, and overlooking the need for condom use if one partner is HIV positive.
- Adequate Attitude: Defined as recognizing susceptibility to HIV, understanding the necessity of HIV testing in health services and during pregnancy, and recognizing the need for condom use if one partner is HIV positive.
- Adequate Practice: Defined as having done an HIV test during pregnancy or rapid testing in maternity and consistently using condoms in all relationships.
- Inadequate Practice: Defined as not undergoing HIV testing or rapid testing and not using condoms consistently.
Current Evidence and Gaps
UNAIDS reports that in 2025, 88% of all people living with HIV knew their HIV status, 89% of those who knew their status were accessing treatment, and 95% of those accessing treatment were virally suppressed. A 2025 review examines pregnancy and HIV through birthing-person and fetal health outcomes, prevention of perinatal transmission, treatment, care, current guidelines, and management challenges in the United States. A systematic review notes that maternal HIV research has historically emphasized prevention of mother-to-child transmission and child outcomes, with less attention to mothers' health outcomes. Research on childbirth experiences also identifies women of reproductive age as an increasingly affected demographic in Canada and reports a transmission rate of less than 1% within the cited Prevention of Mother-to-Child Transmission Program.
Limits of HIV Testing
HIV prevention depends on accurate diagnosis, but a screening result alone is not sufficient to establish that someone is HIV-positive. The WHO states that no single test can provide a full HIV positive diagnosis. Confirmatory testing must be conducted by a qualified and trained health worker or community worker.
Choice Across the Continuum
Reviews of HIV prevention during pregnancy and the postpartum period describe multiple tools for primary prevention among pregnant and postpartum women. They also identify opportunities to improve how these tools are used and their impact across the pregnancy-care continuum. One review highlights a growing pipeline of PrEP agents using alternative delivery platforms that may better suit women's preferences. This supports the view that choice is important for improving HIV prevention coverage.
Implications for Nursing and Public Health
The study highlights the critical need for enhanced health education and nursing care during the puerperal cycle. Addressing the misconceptions and gaps in knowledge about HIV transmission and prevention is essential for reducing the risk of vertical transmission and improving maternal and child health outcomes. The nursing team plays a crucial role in promoting these changes by improving the knowledge, attitudes, and practices of women.
Living With HIV and Motherhood
A meta-analysis identifies HIV-related disease as the leading cause of death among women of reproductive age globally in the cited UNAIDS 2015b data. It also emphasizes the long-term consequences of HIV for reproductive-age women who are planning to reproduce, experiencing pregnancy, and living as mothers. The analysis calls for greater clinician awareness and additional research. A 2024 childbirth-experience review further indicates that a positive childbirth experience is especially important for pregnant women living with HIV because it supports adherence to care.