Screening for Human Immunodeficiency Virus Infection

Clinical Recommendations

The Women’s Preventive Services Initiative recommends prevention education and risk assessment for human immunodeficiency virus (HIV) infection in adolescents and women at least annually throughout the lifespan. All women should be tested for HIV at least once during their lifetime. Additional screening should be based on risk, and screening annually or more often may be appropriate for adolescents and women with an increased risk of HIV infection.

Screening for HIV is recommended for all pregnant women upon initiation of prenatal care with retesting during pregnancy based on risk factors. Rapid HIV testing is recommended for pregnant women who present in active labor with an undocumented HIV status. Screening during pregnancy enables prevention of vertical transmission.

Implementation Considerations

The Women’s Preventive Services Initiative recommends as a preventive service for women, prevention education and risk assessment for HIV infection in adolescents and women at least annually throughout the lifespan. More frequent screening for high-risk women, as determined by clinical judgment, is also recommended as a preventive service. Annual or more frequent HIV testing may be needed and is recommended as a preventive service for women who are identified or self-identify as high risk.

This recommendation refers to routine HIV screening, which is different from incident-based or exposure-based HIV testing. Risk factors for HIV infection in women include, but are not limited to, being an active injection drug user; having unprotected vaginal or anal intercourse; having multiple sexual partners; initiating a new sexual relationship; having sexual partners who are HIV-infected, bisexual, or injection drug users; exchanging sex for drugs or money; being a victim of sex trafficking; being incarcerated (currently or previously); and having other sexually transmitted infections.

Approximately 20–26% of infected patients are not identified by risk-based screening. Early detection and treatment improves outcomes for patients and reduces transmission; therefore, based on clinical best practice, screening annually or more frequently may be reasonable.

*These are the recommendations of the WPSI and not necessarily of any individual participating organization.