Venepuncture Technique Research Articles

L- Arginine and Nitric Oxide Levels Among Children with Sickle Cell Disease Presented With Vaso-Occlusive Crisis in Federal Teaching Hospital Gombe, North Eastern Nigeria.

Aim: The Aim of This Study Is To Evaluate The Level Of L- Arginine And Nitric Oxide Levels Among Children With Sickle Cell Disease presented with vaso-occlusive crisis in pediatric department, Federal Teaching Hospital Gombe, North Eastern Nigeria. Methology: The area selected for this study was Federal Teaching Hospital (FTH), Gombe, Nigeria. Gombe State is located in the North- estern part of Nigeria. This study included 60 children aged 1-14 years with a confirmed HbSS electrophoretic pattern presented to the sickle cell clinic unit of Federal Teaching Hospital Gombe, Gombe State. About 5 millilitres of blood sample was collected from each subject aseptically using the venepuncture technique. The blood was collected into tubes containing dipotassium ethylenediamine tetra-acetic acid (K2EDTA) anticoagulant and the remaining samples was left undisturbed at room temperature and later centrifuged at 3000rpm for 5minutes to obtain clear non- haemolysed plasma. The plasma was transferred into sterile labelled test tubes and assayed (in batches) for l-arginine and Nitric Oxide. Results: This study included children with a confirmed HbSS electrophoretic pattern aged 1-14 years with mean age 7.4500 ±0.50613 years, Presented to the sickle cell clinic unit of Federal Teaching Hospital Gombe, Gombe State. There was a statistically significant difference between the baseline and post L-arginine supplementation. The L-arginine and nitric oxide were significantly higher post supplementation compared to baseline levels among sickle cell disease subjects with vaso-occlusive crisis (p= 0.001and 0.01 respectively).

Effects of Gravidity on Atherogenic Indices in Normotensive and Hypertensive Second Trimester Pregnant Women

Background: Pregnancy results in certain physiological and metabolic changes that results to shift in certain biochemical markers and could even result in hypertension in some women thus predisposing them to risk of cardiovascular disease. While this is true, some women express these predisposing risk factors in subsequent pregnancies. Therefore, it may be a significant contribution to understand the dynamics of artherogenic indices with increasing number of pregnancies.
 Aim: The goal of the study was aimed to assess gravidity effect on artherogenic indices in both normotensive and hypertensive second-trimester pregnant women.
 Materials and Methods: At Rivers State University Teaching Hospital, a cross-sectional study was carried out with 100 pregnant women. The consenting patients who met the inclusion criteria were classified into two groups: normotensive (50 normotensive pregnant women in their second trimester) and hypertensive (50 hypertensive pregnant women in their second trimester) (HPW2T). The participants were subsequently split into three subgroups depending on gravidity: primigravida (no of pregnancy=1), multigravida (no of pregnancies>1), and grand multigravida (no of pregnancies≥5). For the assessment of TC, TG, HDL, and LDL, fasting blood samples were taken using the venepuncture technique. Mathematically, artheriogenic indices (AIP, CR-I, CR-II, AC, and APoB/APoA1) were calculated. At a P-value>0.05, the data was examined using ANOVA and the Tukey comparison test.
 Results: There was no significant difference in artheriogenic indices between the gravidity groups in the normotensive group, with a P-value>0.05, which was also the cases among those in the hypertensive group.
 Conclusion: The study has shown that gravidity does not have any effect on artheriogenic indices among normotensive and hypertensive pregnant women in the second trimester in Rivers State University Teaching Hospital.

Effect of Gravidity on Biochemical Parameters in Normotensive and Hypertensive 3rd Trimester Pregnant Women

Background: Pregnancy is a period in which a woman carries one or more foetus in her uterus. It is typically divided into three trimesters based on gestational age which is measured in weeks and months. Gravidity is referred to the number of times a woman has been pregnant. Pregnancy comes with several changes in metabolism, resulting to changes biochemical markers in pregnant women, some of which to certain extent may pose health risks in those with existing health conditions such as high blood pressure. The study of these changes becomes necessary to determine and arrest the risks should they exist during pregnancy.
 Aim: The study was aimed at evaluating the effects of gravidity on biochemical markers in normotensive and hypertensive 3rd trimester pregnant women.
 Materials and Methods: At Rivers State University Teaching Hospital, a cross-sectional study was conducted on 100 women. The consenting patients who met the inclusion criteria were randomly assigned to one of two groups: normotensive (50 normotensive pregnant women at their third trimester) or hypertensive (50 hypertensive pregnant women at their third trimester) (HPW2T). The subjects in each group were subsequently split into three categories depending on gravidity: primigravida (one pregnancy), multigravida (two or more), and grand multigravida (five or more).
 For the assessment of TC, TG, HDL, and LDL, fasting blood samples were taken using the venepuncture technique.
 AIP, CR-I, CR-II, AC, and APoB/APoA1) biochemical indices were computed quantitatively. At a p<0.05, the data were examined using ANOVA and the Tukey comparison test.
 Result: There was no significant difference in the mean levels of the biochemical parameters among the gravidity groups in the normotensive group except for LDL and APoB levels that was significantly higher, p<0.05. The hypertensive group had no significant difference in the mean levels of all studied parameters among the gravidity group, p>0.05..
 Conclusion: In this study conducted at Rivers State University Teaching Hospital, gravidity had no impact on most biochemical markers in normotensive and hypertensive pregnant women at their third trimester.

Blood collection failures from a blood establishment perspective.

The objective of this study was to show experience of the Croatian Institute of Transfusion Medicine in monitoring and analysing collection failures caused by the venepuncture technique or occurred as a result of adverse reactions and complications experienced by donors during donation. Collection failures represent one of the leading nonconformities in blood establishments. Apart from being a negative motivating factor for blood donors, they also affect the blood components supply and have a negative financial impact. Nonconformity records referring to collection failures were analysed retrospectively over a 6-year period (2013-2018) with regard to their frequency, causes, donor characteristics (age, gender, number of donations), place of occurrence (blood establishment, mobile sessions) and trends during the analysed period. A total of 5166 collection failures out of 618 251 donations (0.84%) were recorded during the analysed period. The leading cause was haematoma at puncture site (1676, i.e., 32.4%). Collection failures which are primarily attributed to the venepuncture technique or vein selection accounted for 91% of all cases, whereas collection failures which occurred as a result of discontinued punctures due to adverse reactions in donors accounted for 9% of all cases. A much higher frequency of all collection failure types was recorded in female donors, whereas younger donors experienced adverse reactions more frequently (median age of 24). The analysis and monitoring frequency of collection failures play an important role in planning of staff training activities, work organisation and timely implementation of corrective actions.

Haematological Alterations among Cement Loaders in Port Harcourt, Nigeria

Background: Exposure to cement dust without necessary precautions to prevent its inhalation is found to cause respiratory, dermatological, ocular as well as hematological problems and this is a matter of great concern to the health of cement loaders.
 Aim of Study: This study was aimed at determining haematological alterations among cement loaders in Port Harcourt, Nigeria.
 Study Design: Cross sectional study design.
 Methodology: A total of 100 apparently healthy male subject consisting of 50 cement loaders and 50 non cement loaders aged between the ages of 20- 45years old were recruited for the study. Four millilitres (4 mls) of blood was collected aseptically from the antecubital vein of each participant using standard venepuncture technique into ethylene diamine tetra acetic acid (EDTA) anticoagulated vacutainer bottles with proper mixing to avoid blood clotting and then analysed using Sysmex haematology autoanalyser. Graphpad prism version 6.2 was used to analyse the data obtained.
 Results: Results obtained showed a statistically higher value (p<0.05) in platelet count (p=0.0001), lower values (p<0.05) in haemoglobin concentration (Hb), Packed cell volume (PCV), Mean cell volume (MCV) and Mean cell haemoglobin (MCH) (p=0.0001). No significant difference (p>0.05) was observed in the mean red blood cell (RBC) count value (p=0.3110), white blood cell (WBC) count (p=0.8138) and mean cell haemoglobin concentration (MCHC) (p=0.0584) respectively.
 Conclusion and Recommendation: This study has confirmed that there are haematological alterations among cement loaders in Port Harcourt, Nigeria and these alterations are attributed to inhalation of cement dust during work. It is recommended that cement loaders should be mandated to use appropriate personal protective equipment during work hours and around areas where cement dust are generated.

SUN-208 The Intra-Individual Variability of 11-Ketotestosterone and 11β-Hydroxyandrostenedione

BackgroundEmerging evidence has suggested the 11-oxygenated steroids may be important in the diagnosis and monitoring of hyperandrogenism. Two in particular, 11-ketotestosterone (11KT) and 11β-hydroxyandrostenedione (11OHA4) have been implicated in polycystic ovary syndrome, congenital adrenal hyperplasia, precocious puberty and castration resistant prostate cancer. Despite the interest in these analytes, some of their more fundamental properties have yet to be determined. At present, no data is available that quantifies the biological variation of 11KT and 11OHA4 within individuals over time, this may be important as we look to establish normative reference ranges for these potentially useful analytes.ObjectiveHere we sought to define the intra-individual variability of 11KT and 11OHA4 in serum using LC-MS/MS.MethodBlood was collected from 18 healthy volunteers (8 males, 10 females) on the same day each week over a 10 week period using standard venepuncture technique. After collection, the samples were centrifuged within 1 hour, aliquoted and stored at -20°C (-4°F) prior to analysis. All samples from individual volunteers were analysed by LC-MS/MS in triplicate within the same batch so as to limit analytical variability.ResultsThe mean analytical coefficient of variation (CV%) for the triplicate analysis was 3.2% for 11KT and 3.7% for 11OHA4. No significant difference was observed between the variability of 11KT concentrations in the male and female cohorts; total intra-individual variation for 11KT was 18.0%. Concentrations of 11OHA4 were more variable in the male cohort when compared to the female cohort. This was reflected by differences in their respective intra-individual variations of 32.5% vs 24.8%.SummaryIntra-individual variation is an important consideration when interpreting patient results. Concentrations of 11KT were tightly regulated in both the male and female cohorts with no clear demarcation between the two groups. Although concentrations of 11OHA4 were prone to greater variation over the 10 week period, considerable overlap was observed between the male and female subjects. Our data suggests that 11KT and 11OHA4 concentrations are not significantly affected by the menstrual cycle.

Diabetes mellitus in patients with mental disorders: Prevalence and associated factors

People with mental disorders have comorbid physical illnesses, particularly an increased risk of diabetes mellitus (DM), found in many psychiatric disorders; schizophrenia, major depression and bipolar disorder. This elevated risk is associated with increased mortality, more so, as treatment of such medical conditions is not easily accessible by people with mental disorders. The aim of the paper is to determine the prevalence and associated factors for DM in patients with mental disorders in Kano, northwest Nigeria. In this cross-sectional study, one hundred and fifty-seven consecutive patients, aged 18 years and above, attending the outpatient psychiatry clinic of Aminu Kano Teaching Hospital were recruited. Sociodemographic and clinical characteristics questionnaires were completed. Height, weight and blood pressure were measured. Subsequently 3 mL of blood was taken using aseptic venepuncture technique and glycated hemoglobin (HbA1c) levels were detected, with a cutoff point of 6.5% used for diagnosis of DM. The age of the patients ranged between 18-79 years with a mean (SD) of 35.5 (±10.6) years. Majority of the patients 91 (58%) were female. Schizophrenia was the most common diagnosis (37.6%) The prevalence of DM was 24.2%. A statistically significant association was found between DM and age (P=0.021), duration of illness (P=0.016) and diagnosis of schizophrenia (P=0.027). DM is common in patients with mental disorders. Associated factors for DM in people with mental disorders include increasing age, prolonged duration of illness and a diagnosis of schizophrenia, the latter being an independent predictor of DM in people with mental disorders.

Blood Tests for People with Severe Learning Disabilities Receiving Dental Treatment under General Anaesthesia.

People with learning disabilities (LDs) have poorer health than their non-disabled peers due to failures in reasonable adjustments. One hundred patients with severe LD and challenging behaviour attended for dental treatment under GA, during which routine blood testing was provided. Communication with general medical practitioners (GMPs) and blood test results were evaluated, showing poor communication with GMPs and significant undiagnosed disease among this group. Blood tests generate similar costs in primary and secondary care but a holistic approach to care under GA reduces expenses brought by lost clinical time and resources due to complex behaviours in an out-patient setting. Clinical relevance: This article discusses a holistic approach to healthcare for people with severe LD, including patient outcomes, financial and resource implications, and offers practical guidance on venepuncture technique, which is relevant to many aspects of both community and hospital dental practice.

Prevalence of Malaria and Typhoid Fever Co-Infection: Knowledge, Attitude and Management Practices among Residents of Obuda-Aba, Abia State, Nigeria

A study of prevalence, knowledge, attitude and management practices of malaria and typhoid fever co-infection was carried out among residents of Obuda-Aba, Abia State, Nigeria, between July and September, 2014. Venepuncture technique was used for collection of the blood samples. A total of 245 persons comprising 120 males and 125 females were examined. Field stained thick and thin blood films were used to detect malaria parasites in the samples. Typhoid fever was diagnosed from each blood sample using Widal test kit. Out of the 245 persons sampled, 95(38.78%) tested positive for malaria, 105 (42.86%) tested positive for typhoid fever, 45(37.50%) were co-infected with malaria and typhoid fever among the males and 55(44.00%) were co-infected with malaria and typhoid fever among the females. Co-infection of malaria and typhoid fever was highest in the age group of 61-75 years, 4(100%) among the males and highest in the age group of 16-30 years, 15(83.33%) among the females. On the perception of the possible causes of malaria and typhoid fever, 24 respondents reported excessive fried oil as the cause while 17 respondents stated excessive intake of alcohol. On the perception of the sign and symptoms associated with malaria and typhoid fever, 77 respondents stated loss of appetite, 67 respondents stated fatigue and 70 respondents stated headache. On the practices available for protection against malaria and typhoid fever, 54 respondents reported routine treatments with drugs, 21 respondents stated good sanitary measures while 33 respondents reported access to safe food and water. There is need for massive health education campaign to educate the residents of Obuda-Aba to correct the wrong perception they have about malaria and typhoid fever for effective treatment and control of the diseases.

Study on Anti-hyperglycaemic and Hypolipidemic activity of Nigella Sativa Seeds

Objective: To evaluate the anti hyperglycaemic and hypolipidemic activity of chloroform extract of seeds of Nigella sativa in alloxan induced diabetic rats. Materials and Methods: Alloxon induced (150 mg/kg in normal saline i.p) diabetic rats were given chloroform extract of seeds of Nigella sativa (400mg/kg, 800mg/kg, 1200mg/kg p.o n=6) or Vehicle (Tween 80 dispersion in distilled water) or standard drug Gliclazide(10mg/kg p.o) for 28 days. The blood samples were withdrawn by tail venepuncture technique and analyzed for blood glucose level by commercial glucometer with test strips. For evaluating immediate effects, blood samples were analyzed at 4th, 6th, 8th and 24th hrs. on the first day. For sub-acute study, samples were analyzed for blood glucose on 7th, 14th, 21st and 28th days. On 28th day, after overnight fasting blood samples were withdrawn by cardiac puncture under anaesthesia (Diazepam 5mg/kg + Ketamine 40mg/kg) and lipid profile estimated. Results: The chloroform extract of seeds of Nigella sativa have statistically significant immediate antihyperglycaemic effects – maximum effect after 6 hrs. of administration. On daily administration, it produced sustained fall in elevated blood glucose levels. Both the immediate and sustained effects were maximum in the dose of 800mg/kg of the extract. The extract of seeds of Nigella sativa reduced the Total cholesterol (TC), Triglycerides (TGL) and increased the High density lipoprotein cholesterol (HDL-C). Thus restores the normal lipid profile. Conclusion: It is concluded that single oral administration of chloroform extract of seeds of Nigella sativa decreases the blood glucose levels. Continuous use of the extract has significant and sustained anti hyperglycaemic activity in alloxon induced diabetic rats. It also has a favorable effect on restoring the normal lipid profile. Key Words: Antihyperglycemic activity, hypolipidemic activity, Alloxon, Nigella sativa

Instructional video for teaching venepuncture.

Safe venepuncture technique is a critical skill for health care professionals, to avoid accidental occupational injury. This study investigates whether watching an instructional video improves medical students' ability to perform venepuncture safely. This was a randomised, controlled, assessor-blinded trial that evaluated the utility of an instructional video, with the primary outcome of the ability to perform venepuncture safely. Forty-two second-year medical students were recruited and randomised to receive either video instruction (group A, n = 20) or no intervention (group B, n = 22). Prior to the study, all students attended an instructor-led workshop on venepuncture. During the study, students were paired and instructed to perform venepuncture on a partner. Performance was assessed using a points-based checklist. Pre- and post-study surveys were conducted to assess confidence with technique. The mean total checklist score was higher in group A than in group B, with values of 14.15 and 9.18, respectively (p < 0.0001, maximum 18 points). Mean scores were also higher in group A than in group B among students who performed first (p = 0.008) and students who performed second (p = 0.005) within the pair. From the post-procedure survey, only group A rated increased confidence in performing venepuncture after the study (p = 0.008). Students who watched an instructional video performed venepuncture more effectively and reported greater confidence with the technique. Medical students can benefit from having access to an instructional video on venepuncture as an adjunct to the standard curriculum. Safe venepuncture technique is a critical skill for health care professionals.

Venepuncture technique training vs practice: a survey of foundation year 1 doctors

This survey investigated potential disparity between foundation year 1 doctors' formal undergraduate venepuncture training and their actual clinical practice. Is there still a high prevalence of needle and syringe use?

A practical guide to venepuncture and blood sampling

This article provides an overview of the knowledge and skills required for peripheral venepuncture, including anatomy and physiology, psychological issues, consent, vein selection, infection control, venepuncture technique, sharps disposal and the prevention and management of complications. A period of supervision and assessment of competency is required to consolidate this theoretical knowledge, and practitioners should comply with the policies and procedures of their organisation.

Peripheral blood culture contamination in adults and venepuncture technique: prospective cohort study

Aims:To test the hypothesis that compliance with a hospital protocol on peripheral blood culture (PBC) collection in adults is associated with a reduction in PBC contamination, and to investigate likely...

Percutaneous venepuncture practice in a large urban teaching hospital

Occupational exposure to bloodborne pathogens remains an important and largely preventable issue in hospital practice. This article argues that formal training can increase use of best practice phlebotomy. A survey of at-risk healthcare workers at a central London hospital was conducted to identify factors associated with use of an evacuated blood collection system (BD Vacutainer and gloves while taking blood. Eighty per cent of doctors and 37% of non-doctors performing percutaneous venepuncture did not use the Vacutainer system exclusively. Doctors qualified less than three years were particularly likely to prefer needle and syringe. Venepuncture technique training significantly increased the probability of always using the Vacutainer system from 7% to 46%. The only factor independently associated with glove use was operator experience. There is considerable room for improvement in phlebotomy technique, particularly among junior doctors. The Modernising Medical Careers initiative provides a unique opportunity to implement this.

Satisfaction survey with DNA cards method to collect genetic samples for pharmacogenetics studies

BackgroundPharmacogenetic studies are essential in understanding the interindividual variability of drug responses. DNA sample collection for genotyping is a critical step in genetic studies. A method using dried blood samples from finger-puncture, collected on DNA-cards, has been described as an alternative to the usual venepuncture technique. The purpose of this study is to evaluate the implementation of the DNA cards method in a multicentre clinical trial, and to assess the degree of investigators' satisfaction and the acceptance of the patients perceived by the investigators.MethodsBlood samples were collected on DNA-cards. The quality and quantity of DNA recovered were analyzed. Investigators were questioned regarding their general interest, previous experience, safety issues, preferences and perceived patient satisfaction.Results151 patients' blood samples were collected. Genotyping of GST polymorphisms was achieved in all samples (100%). 28 investigators completed the survey. Investigators perceived patient satisfaction as very good (60.7%) or good (39.3%), without reluctance to finger puncture. Investigators preferred this method, which was considered safer and better than the usual methods. All investigators would recommend using it in future genetic studies.ConclusionWithin the clinical trial setting, the DNA-cards method was very well accepted by investigators and patients (in perception of investigators), and was preferred to conventional methods due to its ease of use and safety.

Evaluation of an ultrasonically guided venepuncture technique for the placement of permanent pacing electrodes.

We have evaluated a method of puncturing the subclavian vein in its extrathoracic portion using an ultrasound guidance system. Seventy consecutive patients requiring permanent pacemakers were included in the study. The method was successful in 56 (80%) cases (23 dual chamber systems) and unsuitable or unsuccessful in 14 (20%) cases (2 dual chamber systems). The time taken to achieve a successful cannulation of the vein was similar to that taken with conventional subclavian venepuncture (average time taken for each venepuncture was 31 seconds, range 5-130 seconds). There was a significant "learning curve" in that nearly all of the unsuccessful cases were in the first half of the series. There were no major complications. Computerized Tomography (CT) confirms that the point of entry into the subclavian vein using this technique lies outside the thoracic cavity, thereby minimizing the risk of pneumothorax. This approach to the subclavian vein is an easy technique to learn, with few immediate complications and there may be less chance of lead fracture due to subclavian crush in the longer term.

The use of filter paper as a transport device for serology of Pasteurella multocida infection : Analysis and comparison ofprotein composition of filter paper extract and serum

Two methods for collecting blood specimens for measuring antibody to Pasteurella multocida were compared. Blood was collected on filter-paper strips, air-dried and stored at 4°C along with paired samples collected by venepumeture . Analysis using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) showed that the protein composition of filter paper extract and serum was similar. Both samples had common proteins of 67, 52-58 and 27 kDa. However, there are two proteins bands of 14 and 30 kDa that were only found in, filter-paper extract. Westernblot analysis also showed that samples from both sampling techniques reacted to P. multocida proteins of 43 kDa. Samples from experimental and field animals were also collected by the two techniques and assayed by enzyme-linked immunosorbent assay (ELISA) for P. multocida antibodies . The agreement between samples from experimental animals and the field using ELISA was analyzed . Samples from experimental animals, showed a very high correlation (r = 0.931) in ELISA results among samples collected by the two techniques. However, the correlation was lower (r = 0.799) in samples collected from the field. Cost analysis showed that filter-paper collection technique was 100 times more economical compared to venepuncture technique. It was concluded that eluates of whole blood dried on filter paper can be used as an alternative to sera in ELISA for measuring antibodies to P. multocida. Key words : Pasteurella multocida, serological tests, filter paper

Fistula dysfunction: effect on rapid hemodialysis.

Rapid hemodialysis (Qb 400 to 500 ml/min) places considerable demands on hemodialysis vascular access. This six-month prospective study enrolled 52 patients and evaluated urea recirculation as a means of detecting fistula dysfunction. It evaluated the effects of fistula location and dialysis blood flow on urea recirculation during rapid hemodialysis and assessed the effect of rapid dialysis on fistula thrombosis. Urea recirculation increased as Qb increased from 300 to 400 ml/min (8 +/- 3% to 16 +/- 3%, P less than 0.05). The extent of urea recirculation was also fistula site dependent (radial fistulas 18 +/- 4%, upper arm fistulas 11 +/- 3%, Qb 400 ml/min, P less than 0.05). Site and blood flow dependent urea recirculations were an indicator of venous stenoses. When venous stenoses were corrected, urea recirculation rates improved (36 +/- 3% to 21 +/- 3%, P less than 0.05). There were no differences between methods of determining urea recirculation early in dialysis (contralateral arm venepuncture vs. stop flow technique; 30 to 60 min). However, at 120 minutes urea recirculation was significantly greater with the contralateral arm venepuncture technique. Venous dialysis pressure at Qb 400 ml/min had limited use as a predictor of venous stenoses unlike its value at lower Qb. Fistula thrombosis (0.26/patient year of dialysis) and fistula replacement (0.09/patient year of dialysis) were similar to our observations in a conventional hemodialysis facility where prospective correction of fistula dysfunction was also used.

PREVALANCE AND ASSOCIATED RISK FACTORS FOR SYPHILIS IN WOMENS WITH RECURRENTS MISCARRIAGE

A Cross Sectional population based serological studies was conducted to determine the prevalence and associated risk factors for syphilis women with recurrent miscarriages. Patient's 5ml whole blood was collected through venepuncture technique. Data were collected by all women answered a questionnaire and by investigating blood sample VDRL test and FTA-ABS test. The study was conducted in a confidential manner and numbers were used to identify the participant. Total 256 women were included in the present study. Mean age of women was 29.4 years while range was 21 to 38 years (206/256). Out of the 256 samples, 05 (1.9%) were positive for active syphilis. Majority belonged to low socioeconomic group, uneducated and had previous congenital anomaly. Active infection with Treponema pallidum (T.P) in women belonging to low socioeconomic level were disquieting. This is probably due to illiteracy and high proportion of unsafe sexual behavior. It is also suggestive that seropositive status is often discovered in routine serological studies during pregnancy.