Trends in HIV-1 and HIV-2 prevalence and risk factors in pregnant women in Harare, Zimbabwe.

ABSTRACT

The spread of the human immunodeficiency virus (HIV) and the resulting morbidity and mortality are major public health challenges with adverse social and economic implications. The pregnant population serves as an important marker of the extent of the problem in the sexually active low risk categorized population. Furthermore, a high HIV prevalence among women of childbearing age contributes to neonatal and infant mortality through perinatal transmission and also a large number of uninfected children become orphans. The objective of the present study was to determine the HIV prevalence rate and the risk factors in pregnant women attending antenatal care clinics in the Greater Harare area of Zimbabwe. Women presenting for antenatal care in four maternity clinics between May 1994 and June 1995 were tested for HIV-1 and HIV-2 antibodies following informed consent, counselling and completion of a questionnaire. Of the 1.168 women, 30.4 pc tested HIV-1 positive, with prevalence rates ranging from 23.6 pc at a lower density clinic, 28.6 pc in a medium density clinic, 30.7 pc in a higher density clinic and 33.2 pc at the referral maternity hospital. HIV-2 was present in 7.6 pc of the women. The 20 to 29 years age group had the highest HIV prevalence of 35 pc, (Odds Ratio (OR) = 2.4; 95 pc CI-1.33 to 4.32). Single pregnant women were more likely to test positive, (OR = 2.1; 95 pc CI = 1.2 to 3.7). Thirty five pc of the women reported previous use of condoms and in those where condom use was reported in casual relationships, there was a higher risk of HIV (OR 6.1; 95 pc CI = 2.1 to 17.3). Reported use of intravaginal herbs was associated with HIV risk (OR 1.4; 95 pc CI = 1.1 to 1.8; p < 0.03). History of genital ulcer (OR = 2.3), discharge (OR = 2.4), rash (OR = 2.7), genital ulcer with PID (OR = 5.8) was significantly associated with HIV infection. Present findings indicate a 30.4 pc HIV prevalence rate for a sample of 1,168 pregnant women in Harare. This rate is much higher than the 18 pc HIV prevalence rate reported for 1,008 pregnant women in the same Greater Harare area in 1990. We conclude that there is need for further innovative and aggressive community based as well as institutional interventions aimed at reducing HIV risk. Prevention strategies should include a wide range of socially contextualized initiatives.

ABSTRACT

PIP During May 1994-June 1995 in Zimbabwe, after informed consent and HIV counseling, 1168 pregnant women attending their first prenatal care visit at Harare Maternity Hospital and three Harare-based maternity clinics had blood taken to test for HIV-1 and HIV-2. The study aim was to determine the HIV prevalence and risk factors for HIV infection among pregnant women. 30.4% tested positive for HIV-1 (compared to 18% for a similar group in 1990). The HIV-1 prevalence ranged from 23.6% at the lowest density clinic to 33.2% at the referral maternal clinic of the hospital. 7.6% tested positive for HIV-2. Risk factors for HIV-1 infections included being 20-29 years old (odds ratio [OR] = 2.1), unmarried (OR = 2.1), unemployed (OR = 2.1); use of condoms in casual relationships as opposed to with husband or boyfriend (OR = 6.1); having a partner who frequented the bar everyday, every weekend, or twice per month (OR = 2); and history of sexually transmitted disease (STD) (OR = 2.3). Medical conditions associated with HIV-1 infection were palpable lymph glands (OR = 10.8), weight loss (OR = 4.5), and chronic diarrhea (OR = 2.2). STDs associated with HIV-1 infection included genital ulcer (OR = 2.3), genital discharge (OR =2.4), genital rash (OR = 2.7), and genital ulcer with pelvic inflammatory disease (OR = 5.8). The researchers recommend multisectoral and multilevel interventions to prevent HIV infections at all socioeconomic levels.