Prevalence and risk factors for HIV infection in pregnant women in north Trinidad / Prevalencia y Factores de Riesgo por Infección de VIH Entre las Gestantes del Norte de Trinidad

BACKGROUND: The prevalence of Human Immunodeficiency Virus (HIV) infection in the Caribbean is reported to be second only to sub Saharan Africa. HIV in pregnancy has become an increasingly important focus of attention in HIV research because of its role in contributing to spread of the infection. This study sought to establish the prevalence and risk factors associated with HIV infection among antenatal women in the northwest region of Trinidad. SUBJECTS AND METHODS: Using a cross-sectional survey design, interviews were conducted with each new pregnant attendee to the antenatal clinics in the county of St George West over a six-month period after informed consent was obtained. These women were all offered routine HIV testing in their antenatal assessment. Their HIV results were confirmed through the island's HIV monitoring facility. The interviews included questions on demographics, known risk factors for HIV infection, mental health history and related information on their partners. Women who had refused testing were also asked to give reasons for this. RESULTS: There was a total of 541 women attending the clinic for the first time during the six-month period Seven of them refused testing. Of the remaining 534 women, 37 were HIV positive (6.8%). Fourteen of the HIV positive women (37.8%) admitted to knowing of their status prior to becoming pregnant. Risk factors significantly associated with positive HIV status were early age of first sexual intercourse, a history of sexually transmitted disease, mental health problems and homelessness. Regression analysis established a history of sexually transmitted disease as the only independent predictor of HIV infection in this sample. CONCLUSION: These findings reveal a high rate of HIV infection among pregnant women in northwest Trinidad and suggest that having a history of sexually transmitted disease is a key determinant of this. Prevention efforts must therefore be targeted at identifying the factors which influ...

Antecedentes: Se reporta que la prevalencia de infección por VIH en el Caribe, ocupa el segundo lugar detrás del África subsaharana. Debido al papel que juega en diseminar la infección, el VIH en los embarazos se ha convertido cada vez más en foco de atención de las investigaciones de VIH. Por tal motivo, nos dimos a la tarea de establecer la prevalencia y los factores de riesgo asociados con la infección por VIH entre las mujeres que reciben cuidados antenatales en la región noroccidental de Trinidad y Tobago. Sujetos y métodos: Usando un diseño de encuesta transversal, se llevaron a cabo entrevistas con cada nueva embarazada atendida en las clínicas antenatales en el condado de Saint George West, por un período de seis meses, tras de obtener consentimiento informado. A estas mujeres se les aplicó pruebas de VIH de rutina en su valoración antenatal. Los resultados de sus pruebas de VIH fueron confirmados en la instalación de monitoreo de VIH de la isla. Las entrevistas incluyeron preguntas sobre datos demográficos, factores de riesgo conocidos en las infecciones por VIH, historia de salud mental, así como información relacionada con sus parejas. A las mujeres que rehusaron hacerse las pruebas, se les preguntó también sus motivos para el rechazo. Resultados: Hubo un total de 541 mujeres que asistieron a la clínica por primera vez durante el período de seis meses. Siete de ella rechazaron las pruebas. De las restantes 534 mujeres, 37 resultaron VIH positivas (6.8%). Catorce de las mujeres positivas al VIH (37.8%), admitieron conocer su condición antes de salir embarazadas. Los factores de riesgo...

HIV infection rates and associated factors in high risk patients admitted to a psychiatric hospital in Trinidad and Tobago

We investigated the rate of HIV infection in patients at the St Ann's psychiatric hospital in Trinidad and Tobago, and identified the demographic and clinical variables associated with infection. Patients admitted to the hospital were tested for HIV when details of their sexual history suggested that they might be at high risk of infection. We examined hospital records for the 1991-1995 period. During that time a total of 1,227 patients were tested, of whom 84 (6.9) were confirmed positive for HIV. Since there was a total of 11,203 admissions over the period, the minimum infection rate for all patients was 0.75. Among the high-risk group tested, being positive for HIV was associated with age (p = 0.01) and ethnicity (p = 0.003). The highest rates of infection were in the 15-44-year age group while the rates in patients of African and mixed ethnicity were higher than in East Indians. When the underlying diagnoses were examined, the highest rates were found in patients with substance abuse problems, especially those who abused cocaine (p < 0.001). Patients who were VDRL reactive were also more likely to be HIV positive than other patients (p < 0.001). These findings indicate that psychiatric patients are at greater than average risk for HIV infection. Mental health specialists may need to be trained in sexual health counselling to facilitate preventive intervention for this high-risk group.