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Brewer, D. D., Roberts, J. M., Jr., & Potterat, J. J. Punctures during prenatal care associated with prevalent HIV infection in sub-Saharan African women. Presentation at the 17th meeting of the International Society for Sexually Transmitted Diseases Research, Seattle, July, 2007. Presentation available at SSRN:

Pregnant and post-partum women in sub-Saharan Africa experience especially high HIV incidence not explained by sexual behavior. Throughout Africa, many pregnant women receive prenatal healthcare in facilities with very poor infection control.

We analyzed data on punctures during prenatal healthcare and prevalent HIV infection from probability household sample surveys (Demographic and Health Surveys) in 11 sub-Saharan African countries. We included women in our analyses if they had given birth in the prior 5 years and had not tested for HIV previously.

Women who received a tetanus toxoid vaccination and/or phlebotomy during prenatal care for their last pregnancies were more likely to be infected with HIV than women who did not have punctures during prenatal care (AOR = 1.42, 95% CI 1.19-1.69, in a fixed effects multiple logistic regression model, adjusted for country). This association remained robust after we adjusted for demographics and sexual behaviors (AOR = 1.29, 95% CI 1.08-1.54). The model fit did not improve significantly when we included the interaction between prenatal punctures and country. Each type of puncture was independently associated with HIV infection when we included them in the same model together (phlebotomy AOR = 1.22, 95% CI 1.06-1.40; tetanus vaccination AOR = 1.17, 95% CI 0.99-1.37).

The modest association between punctures in prenatal healthcare and prevalent HIV infection highlights the need for universal precautions in all invasive healthcare and rigorous investigations of HIV transmission in sub-Saharan Africa.

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