Factors associated with non-disclosure of HIV infection status of new mothers in Bangkok.

The objective of this study was to estimate HIV disclosure rates and identify factors that predict non-disclosure in Thai women who tested HIV positive during pregnancy or at delivery. This was a cohort study evaluating the implementation of prevention of mother-to-child HIV transmission programs at two Bangkok hospitals in 1999-2003. All HIV-infected women who delivered during the study period were enrollment eligible. Thai-language questionnaires were used to collect baseline data before discharge from the hospital. At the 1 and 4 month follow-up visits, women were asked if they had disclosed their HIV status. Of the 799 women who enrolled, 647 (81.0%) completed follow-up at 1 and 4 months. Four hundred fifty-three (70.0%) women disclosed their status by 1 month. Of the 194 women who had not disclosed by 1 month, 48 (24.7%) had disclosed their status by 4 months. An independent increased odds of non-disclosure by 1 month was associated with not having a partner tested for HIV (OR=5.83, 95% CI=3.19-9.08) or not knowing if the partner was ever tested for HIV (OR=1 3.02, 95% Cl=5.26-32.28), first learning of HIV positive status during delivery (OR=6.84, 95% CI=2.36-19.81) or after delivery (OR=3.14, 95% CI=1.57-6.26) and having >2 lifetime sexual partners (OR=1.71, 95% CI=1.04-2.82). Not living with a partner every day was associated with non-disclosure by 4 months in those women who had not disclosed by 1 month (OR=2.28, 95% CI=1.43-3.64). Despite high rates of disclosure by 1 month, 22.6% of women still had not disclosed their HIV status to their partners by 4 months. The benefits of disclosure warrant effective interventions targeted at women at risk for non-disclosure.

Epidemiology of latex allergy among healthcare personnel at Siriraj Hospital.

AIIergic reactions to latex allergens, ranging from contact dermatitis, urticaria, angioedema, rhinoconjunctivitis, asthma and life-threatening anaphylaxis, have been increasingly recognized among healthcare workers. However, this problem has neither been studied nor reported in Thailand. The objectives of this study are : to (a) delineate the prevalence of latex allergy among healthcare workers in Thailand ; (b) determine the risk factors for the development of latex allergy among hospital personnel in Thailand ;(c) study clinical presentation of latex allergy among those with and without positive latex skin testing ; and (d) undertake a preliminary electrophoretic pattern study of latex proteins contained in latex extracts made from latex gloves commonly used in Siriraj Hospital. The method included a questionnaire survey which was completed by 405 health personnel. The questionnaire pertained to allergy history to latex products. Skin-prick testing, using latex glove extracts, was performed in 227 subjects. Sodium dodecyl sulphate polyacryamide gel electrophoresis (SDS-PAGE) was performed with protein extract preparations from latex gloves. The results showed that 50 subjects reported experiences of one or more latex-related allergic symptoms amounting to a prevalence of 12.4 percent (95 per cent confidence interval {CI}, 9.2 to 15.6). Seven of 227 participants (3.16 per cent) had positive skin-prick tests to latex. The following risk factors were significantly associated with latex allergy : age more than 35 years old (odds ratio {OR} = 2.58; 95 per cent CI = 1.35- 4.93), having a history of prior atopic diseases (OR = 2.06; 95 per cent CI = 1.08-3.93), and having worked with latex gloves for more than 10 years (OR = 2.00; 95 per cent CI = 1.05 –3.82). The most commonly reported symptoms of latex allergy were skin reactions (98 percent). Other symptoms such as rhinitis, conjunctivitis, asthma and anaphylaxis were encountered with lower frequencies. A preliminary study of the electrophoretic pattern of latex glove extracts revealed distinguishable protein bands at 14 kd, 20 kd and 30-43 kd. In conclusion, latex allergic symptoms are common complaints among healthcare personnel in Thailand. Severe symptoms, including anaphylaxis, were noted in one patient. Potential risk factors identified are age more than 35 years old, history of prior atopic diseases, and long contact duration with latex gloves. Measures to cope with such problems will need to be designed for such individuals in the future.