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Risk factors for HIV infection overlooked in routine antenatal care
J Hawken1, T Chard, K Costeloe
1Department of Obstetrics & Gynaecology, Medical College of St Bartholomew's Hospital, London, England.
Insights
Standard antenatal clinic interviews often miss human immunodeficiency virus (HIV) risk factors, particularly those related to heterosexual transmission from partners traveling or residing in high-prevalence areas. Universal HIV testing is recommended.
Area of Science:
- Public Health
- Epidemiology
- Infectious Diseases
Background:
- Standard antenatal clinic history-taking may fail to identify human immunodeficiency virus (HIV) risk factors.
- Heterosexual transmission is a significant route of HIV spread, particularly in certain global regions.
Purpose of the Study:
- To assess the effectiveness of routine history-taking in detecting HIV risk factors among antenatal attendees.
- To evaluate the prevalence of undisclosed HIV risk factors in a multi-ethnic London population.
Main Methods:
- A study involving 1264 women in an inner London health district who underwent HIV testing and a detailed personal interview.
- Data collection focused on personal and partner-related risk factors for HIV infection.
Main Results:
- 39% of women reported HIV risk factors, most not disclosed during routine history-taking.
- A significant proportion of risks involved residence or activities in World Health Organization (WHO) Pattern 2 countries (heterosexual spread regions).
- Partner's bisexual activity and drug injecting were infrequently disclosed.
Conclusions:
- Routine history-taking is insufficient for detecting many HIV risk factors, especially those linked to heterosexual transmission from partners.
- Findings support universal voluntary HIV serum testing in antenatal settings, rather than selection based on disclosed risk factors.
Abstract:
We have ascertained the extent to which risk factors for HIV infection may escape detection by standard history-taking procedures in an antenatal clinic. This study was based on 1264 women from a multi-ethnic population in an inner London health district (City and Hackney). All had agreed to undergo attributable HIV testing and a detailed personal interview. Thirty-nine per cent (494 of 1264 women) reported risk factors contributed personally or by a partner. Most of these risk factors had not been earlier disclosed by routine history taking. In most cases the risk was residence and risk activity in a World Health Organization (WHO) Pattern 2 country. [HIV spread WHO categories: Pattern 1--principally homosexual/bisexual males and i.v. drug use (areas = North America, Western Europe, Australasia, parts of South America) with male to female ratio 10/1; Pattern 2--Heterosexual (areas = Sub Saharan Africa, Caribbean and part South America) with male to female 1/1.] Thirty-one subjects (2.4%) were aware that their partners had participated in bisexual activity. Only six subjects perceived themselves at risk through their own or partner's drug injecting activity. The frequency of risk factors was substantially greater than that ascertained by the routine history. The findings highlight the potential risk of heterosexual spread resulting from travel to or residence in high prevalence territories. The contribution by male partners is significant and is particularly difficult to detect during a routine interview. These data support the recommendation that voluntary HIV serum testing should be universal rather than a selective offer based on risk factors determined at a routine history.