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
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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