Voluntary counseling and testing services for HIV and sexually transmitted infections among pregnant women in China

Abstract

⁎ Corresponding author at: NingboMunicipal Center for Disease Control and Prevention, 237 Yongfeng Road, Ningbo, Zhejiang 315010, China. Tel./fax: +86 574 87271093. E-mail address: xugz@nbcdc.org.cn (G. Xu). In 2009, the Chinese Ministry of Health estimated that approximately 230 000 women aged 15 years and older were living with HIV/AIDS in China [1]. However, a substantial proportion of these women did not know their HIV status. In the same year, UNAIDS estimated that 370 000 children worldwide were infected with HIV during the perinatal and breastfeeding period. More than half of all people living with HIV/AIDS worldwide are women of childbearing age [2]. Voluntary counseling and testing (VCT) is widely recognized as an effective and important strategy for both prevention and treatment, and an essential tool in controlling the HIV/AIDS epidemic [3]. Therefore, VCT services for pregnant women can have a major role in containing the spread of HIV infection via mother-to-child and heterosexual transmission. However, HIV-related stigma and discrimination against people infected with HIV/AIDS are chief among the barriers preventing people from seeking VCT [4]. Research about VCT in China has targeted mainly high-risk groups such as injecting drug users and female sex workers. In 2009, UNAIDS called for the virtual elimination of mother-to-child transmission of HIV by 2015. The present study was designed to examine this issue by exploring knowledge and behavior related to HIV and sexually transmitted infections (STIs) among pregnant women using VCT services. The present cross-sectional descriptive study involved 800 pregnant women attending 2 VCT centers at public maternal-and-child-health clinics in Ningbo, China. Data were collected between March 1 and June 30, 2010. Ethics approval was obtained from Ethics Board of the Chinese Center for Disease Control and Prevention (China CDC). All individuals presenting voluntarily for HIV counseling and testing were approached by trained doctors who explained the purpose of the study and invited them to participate. All participants provided informed oral consent. Upon completion of consent procedures and before HIV and syphilis testing, participants were administered a China CDC-designed questionnaire. Data were collected as part of routine HIV and STI surveillance activities, and included information on social and demographic indicators, and HIV/AIDS-related knowledge and behavior. Data were analyzed using SPSS version 11 (SPSS, Chicago, IL, USA). Logistic regression analysis using the χ test was performed to evaluate the data obtained. Pb0.05 was considered to be statistically significant. Of the 800 pregnant women included in the analysis, 335 (41.9%) were 17–25 years of age, 355 (44.4%) were 26–30 years of age, and 110 (13.8%) were 31–41 years of age. The mean age of the participants was 26.6±3.7 years. Overall, 458 (57.2%) were primigravidas and the remaining 342 (42.8%) were multiparas; 217 (27.1%) had undergone primary education, 203 (25.4%) had graduated from secondary school, and 380 (47.5%) had received higher education; 780 (97.5%) were married, with 6 (0.8%) declaring that their husbands were injecting drug users; 187 (23.4%) were migrant women; and 3 (0.4%) declared that they had a history of STIs. Of the 687 (83.9%) pregnant women who correctly answered questions regarding the mode of HIV/AIDS transmission, most were older (χ=21.0; P=0.01), married (χ=5.4; P=0.02), local registers (i.e. not part of the migrant population [χ=6.1; P=0.01]), and had undergone higher education (χ=18.3; P=0.01). According to logistic regression analysis, age and education level were associated with knowledge of the mode of HIV/AIDS transmission (Table 1). The results of HIV testing for all participants were negative, although 7 (0.9%) women were infected with syphilis. Voluntary counseling and testing centers represent an ideal setting for screening, counseling, surveillance, and intervention for pregnant women. Further studies at VCT centers should emphasize promoting HIV knowledge and enhancing HIV and syphilis testing among pregnant women—especially less-educated and young women—to reduce the spread of HIV and STIs through mother-tochild and heterosexual transmission.