Routine human immunodeficiency virus infection screening in unregistered and registered inner-city parturients

Women who receive little or no prenatal care are at increased risk of adverse pregnancy outcome. Although many of these women are disadvantaged and presumably at increased risk for human immunodeficiency virus (HIV) infection, few data are available to describe risk behaviors and infection prevalence in this population. To better characterize HIV infection in unregistered inner-city parturients in Atlanta, we offered routine voluntary screening for HIV antibody and requested HIV risk-behavior profiles on all unregistered and registered parturients seen at Grady Memorial Hospital from July 1, 1987 to June 30, 1988. Of the 834 unregistered and 7356 registered parturients screened, significantly more unregistered parturients were seropositive on enzyme-linked immunosorbent assay and Western blot testing, 12 (1.4%) versus 26 (0.4%) (odds ratio 4.06; 95% confidence interval 1.93-8.43). Five unregistered and 15 registered parturients were seropositive by repeat enzyme-linked immunosorbent assay testing but were Western blot-negative. Significantly more unregistered parturients reported both a history of intravenous drug use, 4.4 versus 1.5% (odds ratio 3.09; 95% confidence interval 2.10-4.54), and crack cocaine use, 3 versus 0.8% (odds ratio 3.96; 95% confidence interval 2.42-6.44). Significantly more unregistered parturients acknowledged risk factors for HIV infection, 14.3 versus 9.9% (odds ratio 1.46; 95% confidence interval 1.19-1.80). Nearly all registered and 86% of unregistered parturients consented to HIV testing. Nearly all parturients completed HIV risk-behavior questionnaires. These data suggest that unregistered inner-city parturients in Atlanta are at greater risk of being HIV-infected and are more likely to report risk behaviors for infection.