• Prenatal care: Health care professionals must counsel all pregnant women about HIV and provide HIV testing as early in pregnancy as possible unless they decline or there is documentation that they were previously tested during the current pregnancy. Providers must explain that women may decline HIV testing, but that if they decline testing, HIV testing will be mandatory for the newborn.
  • Third trimester repeat HIV testing: As of January 1, 2018, healthcare professionals who provide healthcare services to pregnant women are required to give HIV counseling and provide repeat opt-out HIV testing during the third trimester, ideally by the 36th week of pregnancy. 
  • Labor and delivery:  As of January 1, 2018, any healthcare professional or hospital caring for a pregnant woman during labor or delivery is required to offer counseling and opt-out rapid HIV testing if that pregnant woman does not have a documented third trimester HIV test. Testing is not required if the pregnant woman has a documented negative HIV test from the third trimester of the current pregnancy or is already documented to be living with HIV. Providers must explain that women may decline HIV testing, but that if they decline testing, HIV testing will be mandatory for their newborn.
  • After delivery: If there is no documentation of maternal HIV testing during the third trimester or at delivery, then mandatory rapid HIV testing of the newborn, as soon as possible within medical standards to determine HIV-exposure, is required. The mother’s or guardian’s consent is not required to test the newborn.


All HIV counseling for pregnant women must be in accordance with the AIDS Confidentiality Act and include:

  • The voluntary nature of testing for pregnant women.
  • The requirement that opt-out testing of the mother be performed, unless she declines, and how to decline.
  • The benefits of HIV testing for pregnant women, including the opportunity to prevent HIV transmission to the newborn.
  • The benefit of HIV testing for the infant, including interventions to prevent transmission, and the side effects of those interventions.
  • The confidentiality provisions that relate to HIV and AIDS.
  • The requirement that if the mother’s HIV status from the third trimester is unknown, the newborn must be tested for HIV.
  • An explanation of the test, including its purpose, limitation, and the meaning of its results.
  • An explanation of the procedures followed.
  • The availability of additional or confirmatory testing, if appropriate.
  • Counseling may be provided in writing, verbally, by video, electronic or other means. The woman must be offered an opportunity to ask questions about testing and to decline testing for herself.
  • All testing of pregnant women must be voluntary. Only newborns whose mother’s HIV status from the third trimester is unknown may be tested without consent.
  • Opt-out HIV testing must be conducted for all pregnant women. They must be provided with counseling prior to HIV testing. Providers must explain that women may decline HIV testing, advise that they will be tested for HIV unless they decline, and informed how to decline testing. They must be counseled on the benefits of HIV testing, and providers must inform women that their newborn will be tested if they are not tested.
  • Any testing and test results must be documented in accordance with the AIDS Confidentiality Act (410 ILCS 305/). All counseling and acceptance or refusal of testing must be recorded in the woman’s medical records.
  • The law requires that the mother’s HIV test results be recorded in her newborn’s chart. The provider must note if the test results are not available because the mother declined testing or was not tested.
  • Testing of women in labor and newborns must be performed by a rapid HIV test.
  • Providers may be fined for violations of the AIDS Confidentiality Act, including failing to provide adequate pre-test counseling.

A positive rapid HIV test is interpreted as a preliminary positive. Because no test can be both 100% sensitive (no false-negative results) and 100% specific (no false-positive results), a given test is typically designed to primarily possess one of these characteristics at the expense of the other. A rapid HIV test is a screening test meaning that it is a sensitive test but not specific. Practically, this translates to more false-positive test results. This is why all positive rapid HIV test results require confirmation with a subsequent supplemental HIV test different from the initial test. In certain situations, such as labor, it may be necessary to initiate treatment prior to obtaining a confirmatory result. Other times treatment can be delayed until a confirmatory test result is obtained. The Illinois Perinatal HIV Hotline is available to help you make these treatment decisions.

A negative rapid HIV test is interpreted as negative. No confirmatory testing is required. If a woman was exposed to the virus within the last 3 months, repeat testing is recommended as the rapid test may not detect a recent infection.

It is critical that when a patient has a positive rapid test result a confirmatory test is sent immediately. A positive result should promptly trigger a call to the Illinois Perinatal HIV Hotline as required by Illinois law. As a team you and the hotline staff will determine the most appropriate clinical and social course to assure the risk of HIV transmission from the patient to her infant is optimally reduced.

During this time it is important to note that a patient’s decision to accept an HIV test and the results of that test are to be kept confidential. Labor and delivery staff need to be vigilant of this at all times. The discussion of test results should occur in an environment where the patient feels comfortable and safe. The patient may not want to disclose information regarding her choice to be tested or the results of the test to her family members, partner, or friends. Ask the patient prior to obtaining the rapid HIV test who she wants present when she receives the results. Only the individuals identified should be in the room when the results are relayed. If English is not the patient’s primary language, interpretation services should be utilized. Staff should not use family members or friends to discuss test results or provide information surrounding the results.

Patients should be counseled that positive test results are only preliminary and that additional testing is necessary to confirm the diagnosis. If she is at risk for delivery she should be informed that the second test will likely not be back prior to delivery of her baby. She should be counseled that antiretroviral medication is recommended to reduce the risk of transmission of the virus to her baby. Additionally, she should be counseled to avoid breastfeeding until confirmatory test results are available.

No. Rapid tests cannot be confirmed with another rapid test. It is important to act quickly and obtain a confirmatory test, report the result, and depending on the scenario initiate treatment.

No. There should be only one rapid HIV test on the mother/baby pair. The best chance for prevention is diagnosis of HIV infection in a pregnant woman. The rapid test detects maternal antibodies to HIV and does not diagnose HIV infection in infants. A different test, a DNA PCR (polymerase chain reaction) test is used to begin the process of determining if the infant is infected. If the mother declines HIV testing, or is missed for HIV testing when pregnant and/or delivering, the baby must be tested (by law in Illinois). If the baby’s test is preliminary positive, it means that maternal antibodies to HIV may have been detected in the baby’s blood. Therefore, it is not necessary to rapid test the mother postpartum after the baby has been tested. A sample may be drawn from the mother for confirmatory HIV testing.