Women's knowledge and attitudes, and the acceptability of voluntary antenatal HIV testing.

OBJECTIVE: To assess pregnant women's knowledge of, and attitudes towards, antenatal HIV testing, and its acceptability to them. SETTING: Antenatal clinic at Guy's Hospital, London, six community antenatal clinics and a midwifery group practice. POPULATION: Eight hundred and forty-three women attending the antenatal clinics. METHOD: The women received a leaflet explaining HIV testing, and completed a questionnaire before and after their booking appointment. This included an assessment of their knowledge of, and attitudes towards HIV testing, and its acceptability. RESULTS: Seven hundred and eighty-nine women (94%) completed questionnaires. Fifty-one percent (n = 405) were Caucasian, 25% (n = 195) African, 11% (n = 86) West Indian and 13% (n = 100) were from other ethnic groups. Fifty-eight percent received the HIV information leaflet, of whom 86% had read it. Knowledge relating to HIV was good, the median knowledge score being 6 out of a possible 8, but it was less in non-Caucasian women and those with lower educational qualifications. Knowledge was not related to uptake of testing. Thirty-five percent of women accepted the offer of an HIV test, rates being higher in hospital clinics (41%) than in the midwifery group practice (10%) and the community clinics (30%). Women more likely to accept the offer of an HIV test were non-Caucasian (P = 0.0443), those who had thought about the HIV test before this pregnancy (P = 0.0298) and those seeing one particular midwife (P = 0.0003). Most women (67%) thought that all pregnant women should be offered the HIV test and then make their own decision. Overall, 64% women did not change their original pre-discussion decision on testing for HIV. Thirty-six percent of women changed their decision from 'yes' to 'no' or 'don't know' after seeing the midwife. Women attending the community clinics (P = 0.003) and those who had been tested before (P = 0.0451) were more likely to change their decision. CONCLUSION: This study, in a multiethnic population, has shown that knowledge regarding HIV is good but does not increase the uptake of testing. Women prefer to be offered the HIV test and make their own choice regarding whether to accept it.

South London Community stroke register (SLSR): Stroke incidence in the first two years of the register (1995-1996)

The aim of this project is to determine whether whether there are ethnic differences in the incidence of first-ever stroke and in the frequencies of different subtypes of stroke. SETTING: An inner-city population of 234,533 residents of Lambeth, Brixton and North Southwark, of which 72 percent are Caucasian, 21 percent are Black (11 percent Afro-Caribbean, 7.5 percent West African, and 2.5 percent Black mixed), and 3 percent are Asian, Bangladeshi and Pakistani. METHODS: Using a multi-source, prospective community stroke register, data on incidence and stroke subtype were collected. Ethnic origin was self-reported by the patient or carer using the standardized OPCS census classification of the group. Stroke subtype was classified using brain radiology (computerized tomography or magnetic resonance imaging) or necropsy data. Strokes without pathological confirmation of stroke subtype using either of these methods were unclassified. RESULTS: A total of 596 strokes were registered in 1995-1996 giving a mean overall annual incidence rate of 1.3 strokes per 1,000 population per year (95 percent C.I. 1.1 -1.4). Incidence of stroke was significanlty higher in all ages in blacks compared with whites (p>0.0001), and the mean age of stroke was significantly lower in blacks compared wih whites (63.5 years, 95 percent C.I. 60.1 - 66.9, and 73.9 years. 95 percent C.I. 74.7 - 72.6, respectively, and p>0.0001). Of the first 500 patients registered, classifications of stroke subtype using information from brain radiology or necroscopy was possible in 441 patients (88.2 percent). There were signfificant ethnic differences in the frequencies of the subtypes of stroke between blacks and whites (p 0.015), with an increased proportion of strokes due to intracranial haemorrhage and lacunar infarction in the blacks (28.4 percent and 29.6 percent) compared with whites (16.4 percent and 24.8 percent), and an increased proportion of non-lacunar infarction in the whites compared with blacks (45.5 percent and 36.4 percent respectively). CONCLUSION: These results suggest important ethnic differences in stroke incidence which probably reflect differences in risk factors for stroke between ethnic groups. These need to be examined further in order to develop effective strategies for stroke prevention in multi-ethnic communities.(AU)

Differences in potentially preventable risk factors for stroke amongst ethnic groups

AIM: To assess the prevalence of risk factors for stroke potentially amenable to health service intervention (hypertension, diabetes, smoking, increased alcohol consumption, physical inactivity, atrial fibrillation, cardiac disease, previous TIA) in black Caribbean, black African and white population of an inner-city health authority. METHODS: A cross-sectional survey was conducted, involving 16 GP Practices serving an area with a high proportion of black residents as identified by the 1991 Census. The FHSA list for these practices was used as the sampling frame. A random sample of 8000 residents (45-74 years old) was selected for a postal survey, which collected data on age, sex, occupation and ethnic group. Responders were stratified by ethnic group. A random sample of 450 subjects in white and black Caribbean group was selected, and together with 193 black African responders invited for screening. RESULTS: There were 725 responders: 303 whites (41.8 percent), 316 black Caribbean (43.6 percent) and 106 black Africans (14.6 percent). Black Caribbeans and Africans were less likely to have a normal blood pressure than whites (OR=0.42, p=0.0001, and OR=0.39, p=0.001 respectively.) Black Caribbeans and were also less likely to have a normal ECG (OR=0.55, p=0.0011, and OR=0.41, p=0.007 respectively.) Left ventricular strain was more common in black Caribbeans (OR=15.81, p=0.008) and Africans (OR=19.97, p=0.007), ischaemic changes were more common in black Caribbeans (OR=2.8, p=0.0001) and myocardial infarction in Africans were found in the prevalence of reported risk factors, such as diabetes (5 percent, 15.2 percent, 10.4 percent respectively, p>0.00001), smoking (31.4 percent, 21 percent, 11.3 percent, p<0.00001, alcohol drinking (80.9 percent, 77.8 percent, 61.3 percent, p<0.00001) and physical activity (75.3 percent, 83.2 percent, 79.3 percent, p=0.048). No difference was found in prevalence of atrial fibrillation and previous TIA. CONCLUSION: Black Caribbeans and black Africans have significantly higher prevalence rates of the important risk factors for stroke. This may partially explain higher mortality rates for stroke in these ethnic groups. Strategies for stroke prevention will be considered in the context of the on-going study on cultural attitudes to risk factor reduction. (AU)