An end to perinatal HIV: success in the US requires ongoing and innovative efforts that should expand globally.

The dramatic reduction of perinatally transmitted HIV in the United States has been a striking success story in the HIV epidemic. Routine HIV screening during pregnancy followed by appropriate therapy has been extremely effective. This paper puts forth three strategies needed to maintain these gains and reach the goal of eliminating perinatal HIV: standardize medical interventions and policy changes that support perinatal HIV reduction; institute HIV screening in routine preconception care to identify HIV infection in women before pregnancy; and critically focus attention and resources on primary prevention of HIV infection in women. Healthcare providers should incorporate HIV prevention education and routine screening into women's primary health care. Public health leaders should support and fund prevention strategies directed at young women. Successful approaches that have nearly eliminated perinatal HIV transmission in the United States offer valuable lessons that should be applied to primary HIV prevention for women in the United States and globally.