Transmission of human immunodeficiency virus by heterosexual contact with reference to antenatal screening

Twenty-seven women all of childbearing age, eight of whom were pregnant, were identified as human immunodeficiency virus (HIV-1) antibody positive in the genitourinary medicine clinics of East Riverside up to March 1987. Of these 27 women 11 had acquired the virus by heterosexual contact. Between 1 March 1987 and 29 February 1988, all 1328 women attending the antenatal clinic were offered an HIV screening test, 982 accepted and the other 346 declined to be tested. Two of the 982 tested women were found to be HIV-1 antibody positive. Two other pregnant HIV-1-positive women were identified during this time, one was tested in the genitourinary medicine clinic and the other whilst an in-patient for drug withdrawal. All except one of the 12 HIV-1-antibody-positive pregnant women were in known high-risk groups. In addition up to March 1988, 32 heterosexual men were identified as HIV-1 antibody positive and 22 of these were intravenous drug abusers. If the present trend continues, more women will become infected, often unaware that they are at risk and this may not be detected unless HIV testing is offered to all pregnant women and widely accepted. Decisions on local policy should be based on the available estimates of prevalence of HIV infection in that community.