Women's HIV needs within a broader spectrum of reproductive health

Abstract

HIV testing and prevention approaches aimed at women have mainly targeted women attending antenatal clinics, even though pregnant women have been found to prefer pre-pregnancy HIV dialogue (Sherr et al., 1996). Surprisingly HIV testing policies and procedures are mostly absent in clinics approached by women who seek elective terminations, even though the prevalence of HIV in this group is threefold compared to women who carry to term (DoH, 1998)) Similarly HIV testing remains 'available on request' for women attending family planning clinics, many of whom report HIV risk behaviours (Radcliffe et al., 1993). In the light of increasing HIV seroprevalence in women of reproductive age, this study aimed to provide a systematic understanding of HIV testing and prevention issues for women attending both antenatal (ANC) (n = 794), family planning (FPC) (n= 145) and termination assessment clinics (TOPC) (n = 141) and to carry out a comparative analysis of the three groups of women in terms of their sample characteristics, HIV testing intentions, HIV knowledge, HIV risk factors and their appraisal of HIV provision. Women in all clinics showed low levels of HIV knowledge. Women in ANCs had the lowest overall HIV knowledge score (F = 3.211, p = 0.041). Fewer than one in four women across the groups were aware of the potential interventions to reduce vertical HIV transmission. Single or multiple potential risk factors were disclosed by over one in five women, TOPC attenders reporting most risks. Not surprisingly these women also reported greater worry about past risks and HIV testing as well as lower perceived control over staying HIV-negative in the future. They were the most likely group to agree that all clinic attenders should receive information about how to prevent HIV infection (chi2 = 10.028, p = 0.007). One in ten women were unsure if they have ever had an HIV test, women in ANCs being most likely to express an intention to test for HIV (36.0%), compared with women in FPCs (10.0%) and TOPCs (17.7%) (chi2 = 44.832, p = 0.0001). HIV risk exposure was prevalent but did not relate to HIV testing intentions. Many women in ANCs (67.2%), FPCs (74.2%) and TOPCs (73.3%) endorsed the offer of HIV testing to every clinic attender. Given the above findings it would appear that women attending reproductive health care clinics other than antenatal clinics agree with the offer of HIV testing and would welcome further information. Both FPCs and TOPCs are settings where HIV service provision aimed at women themselves could be enhanced. The uptake of HIV testing by women attending antenatal clinics remains moderate.