HIV risk perception among pregnant women in western India: Need for reducing vulnerabilities rather than improving knowledge!

Abstract

Since the beginning of the HIV/AIDS epidemic in India, pregnant women attending antenatal clinics (ANC) have been considered as a low HIV risk population. Yet, a substantial proportion of new HIV infections are occurring among stable heterosexual couples. This paper sought to investigate the proportion and profile of women who, within the low-risk population, are potentially at higher risk of HIV infection. HIV risk perception of pregnant women enrolled within the ANRS 12127 Prenahtest trial was described and associated socio-behavioral characteristics, husband's characteristics, and HIV-related characteristics were analyzed using univariate and multivariate logistic regression models. Among 484 women enrolled, baseline data were collected for 479 women and 460 women with completed data were considered for the present analysis (96%). Eighty-nine (19.4%) women perceived themselves at risk of HIV. Women with educational level <11years (Adjusted Odds Ratio, AOR = 2.4 [CI = 1.28-4.53]), who stayed in joint families (AOR = 1.89 [CI = 1.12-3.12]), who had experienced insult or hurt from the partner (AOR = 1.91 [CI = 1.11-3.27]) and whose partner were alcoholic (AOR = 2.19 [CI = 1.31-3.66]) were significantly more likely to perceive themselves at risk of HIV. Women who had heard about sexually transmitted infections were also more likely to report HIV risk perception (AOR = 3.36 [CI = 1.83-6.18]). Substantial proportion of women (one out of five) perceived themselves at risk of HIV and most of these have reported some form of vulnerability in their couple relationship such as intimate partner violence, alcoholic partner, lack of communication, and spaces for communication with partner. Though awareness and knowledge is the first step for prevention, considering the vulnerabilities associated with HIV risk perception, HIV prevention interventions in India should target overall sources of vulnerability to HIV. Targeted risk reduction for women in ANC should be considered for primary HIV prevention among couples.

Being perceived as ‘a real woman’ or following one's own convictions: a qualitative study to understand individual, family, and community influences on the place of childbirth in Busia, Kenya

“…They also had a realistic perception of the risks of both home delivery and of mother-to-child transmission of HIV, which guided them to choose facility delivery regardless of their HIV status. This is in line with findings from Nigeria and India showing high levels of awareness of HIV-related issues among women of reproductive age (Olugbenga-Bello et al 2013;Darak et al 2014).…”

Emergence of HIV Types and Risk Factors in Pregnant Women in Burkina Faso from 2006 to 2014

“…The rate of HIV-2 and HIV-D was higher compared to HIV-1 in non-literate women while HIV-1 prevailed among women in the primary level. These results contrast with those of Ghana where women of secondary and tertiary level were less likely to be infected with HIV than those without primary education (OR = 0.53) [57] and India which revealed that women with less than 11 years of formal education were more likely to have HIV (Adjusted Odds Ratio=2.4). [58] They are comparable with the highest prevalence (13.4%) and 3.9% among non-literate women in Tanzania respectively [56] and Uganda [54].…”

“…This result is different from that mentioned in Uganda stipulating that students had higher risk of HIV infection (AIRR=0.22) [59]. However, it is comparable to other studies especially in Burkina Faso where pupils and students be exposed to the risk of HIV infection was higher (OR=1.68 [1.20 to 2.33]) compared to other types of occupation gathered [41]; in Tanzania where prevalence was higher (13.1%) in commercial [53] [57] women of secondary and tertiary levels had a higher risk of being infected with HIV than those who did not reach the primary level (OR=0.5) and in India suggesting that women with less than 11 years of schooling had less risk of infection (Adjusted Odds Ratio=2.4) [58].…”

PrEP initiation, persistence, and adherence during pregnancy through the postpartum period: a prospective analysis in Kenya

“…Participants with higher perceived HIV risk were also more likely to initiate PrEP, though overall <10% perceived themselves to be at high risk for HIV. Previous studies have shown an imbalanced relationship between perceived vs. actual HIV risk among pregnant women, based on solely self-reported sexual behaviors [49,50]. Low perceived HIV risk is a common reason for declining PrEP among pregnant women, even when male partner HIV status is unknown [51].…”