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This study aimed to assess the attitudes and willingness of pregnant women to receive the influenza vaccine and the factors influencing their decisions. A sample survey was conducted among pregnant women receiving prenatal care at various medical institutions in Minhang District, Shanghai, from March to June 2023. The survey included inquiries about demographic information, knowledge, and perception of influenza disease and influenza vaccine. Logistic regression models and chi-square tests were used to analyze the data. 6.9% (78/1125) of participants considered receiving the influenza vaccine during pregnancy. Participants with graduate education or above (OR = 4.632, 95%CI: 1.046-20.517), non-office workers (OR = 2.784, 95%CI: 1.560-4.970), and participants whose spouses were not office workers (OR = 0.518, 95% CI: 0.294-0.913) were significantly associated with high intent to vaccinate. Participants with superior knowledge (>30 points) exhibited greater willingness ( p  < .001). Participants who viewed post-influenza symptoms as mild had a significantly lower willingness to vaccinate during pregnancy (2.3%), compared to those who disagreed ( p  = .015). Conversely, those recognizing a heightened risk of hospitalization due to respiratory diseases in pregnant women post-influenza were significantly more inclined to vaccinate during pregnancy (8.8%) ( p  = .007). Participants recognizing benefits uniformly expressed willingness to receive the influenza vaccine during pregnancy ( p  < .001), while those perceiving barriers uniformly rejected vaccination ( p  < .001). Higher education, non-office worker status, and having an office worker spouse correlate with greater willingness to receive the influenza vaccine during pregnancy. Enhanced knowledge and accurate perceptions of influenza and its vaccine influenced willingness. Accumulating knowledge about influenza and its vaccine fosters accurate perceptions. Notably, overall willingness to vaccinate during pregnancy remains low, likely due to safety concerns, and lack of accurate perceptions. Targeted health education, improved communication between healthcare providers and pregnant women, and campaigns highlighting vaccine benefits for mothers and children are essential.

Background: Respiratory syncytial virus (RSV) is the world's leading cause of viral acute lower respiratory infections (ALRI) in infants. WHO has identified maternal RSV vaccination a priority and candidate vaccines are in development; however, vaccine hesitancy remains an impediment to successful implementation of maternal immunization. This study, the largest antenatal survey conducted to-date, aimed to examine maternal RSV awareness, likely acceptance of RSV vaccination in pregnancy, and attitudes to maternal vaccination., Methods: Pregnant women of all gestations attending antenatal clinic of a university maternity hospital in Ireland were invited to participate. An information leaflet provided, consent obtained, and survey administered examining RSV awareness, willingness to avail of antenatal RSV vaccination, factors influencing acceptability and preferred sources of assistance. Research Ethics Committee (REC) approval obtained, and general data protection regulation (GDPR) guidelines followed., Results: 528 women completed the survey. A large proportion (75.6%) had never heard of RSV, yet 48.5% would still avail of a vaccine, 45.8% were undecided and only 5.3% would not. The main factor making vaccination acceptable to women (76.4%) was that it protects their infant from illness (p < .001, CV 0.336 for association with acceptance) and general practitioner (GP) was the preferred guidance source in decision-making (57.7%)., Conclusions: Despite low levels of maternal awareness of RSV, pregnant women in Ireland are open to availing of antenatal vaccination. Maternal immunization strategies need to focus on infant's protection from RSV-associated ALRI along with vaccine safety, and build on an interdisciplinary collaboration of maternal, neonatal, primary care and public health services., (© 2024 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

Background: Prenatal anxiety has been a significant public health issue globally, leading to adverse health outcomes for mothers and children. The study aimed to evaluate the sociodemographic characteristics, knowledge, attitudes, and practices (KAP), and anxiety level of pregnant women during the coronavirus disease 2019 (COVID-19) epidemic in Wuhan and investigate the influencing factors for prenatal anxiety in this specific context., Methods: Pregnant subjects' KAP towards COVID-19 and their sociodemographics and pregnancy information were collected using questionnaires. The Zung Self-Rating Anxiety Scale (SAS) was used to assess anxiety status. Factors associated with the level of prenatal anxiety were analyzed by Pearson's chi-square test and multivariable logistic regression analyses., Results: The prenatal anxiety prevalence in this population was 20.8%. The mean score of knowledge was 13.2 ± 1.1 on a 0 ~ 14 scale. The attitudes and practices data showed that 580/ 817 (71.0%) were very concerned about the news of COVID-19, 455/817 (55.7%) considered the official media to be the most reliable information source for COVID-19, and 681/817 (83.4%) were anxious about the possibility of being infected by COVID-19. However, only 83/817 (10.2%) worried about contracting COVID-19 infection through the ultrasound transducer during a routing morphology scan. About two-thirds 528/817 (64.6%) delayed or canceled the antenatal visits. Approximately half of them 410/817 (50.2%) used two kinds of personal protection equipments (PPEs) during hospital visits. Logistic regression analysis revealed that the influential factors for prenatal anxiety included previous children in the family, knowledge score, media trust, worry of contracting the COVID-19 infection and worry about getting infected with COVID-19 from the ultrasound probe antenatal care (ANC) schedule., Conclusion: Prenatal anxiety was prevalent among pregnant women in Wuhan during the outbreak of COVID-19. The current findings identified factors associated with the level of prenatal anxiety that could be targeted for psychological care.

Background: Congenital syphilis is completely preventable through screening and treatment, but rates have been rising in the United States. Certain areas are at particularly high risk. We aimed to assess attitudes, knowledge, and barriers around effective prevention of congenital syphilis among health care providers and community women potentially at risk., Methods: Two parallel studies were conducted: in-depth interviews with health care providers and focus groups with community women in the area of Baton Rouge, Louisiana. Each group was questioned about their experience in providing or seeking prenatal care, knowledge and attitudes about congenital syphilis, sources of information on testing and treatment, perceptions of risk, standards of and barriers to treatment. Results were transcribed into QSR NVivo V10, codes developed, and common themes identified and organized., Results: Providers identified delays in testing and care, lack of follow-through with partner testing, and need for community connection for prevention, as major contributors to higher rates of congenital syphilis. Women identified difficulties in accessing Medicaid contributing to delayed start of prenatal care, lack of transportation for prenatal care, and lack of knowledge about testing and prevention for congenital syphilis., Conclusions: Providers and community members were in broad agreement about factors contributing to higher rates of congenital syphilis, although some aspects were emphasized more by one group or another. Evidence-based interventions, likely at multiple levels, need to be tested and implemented to eliminate congenital syphilis.

This study aimed to investigate the long-term changes in awareness of and knowledge about mother-to-child infections across 6 years in Japan. A questionnaire survey was conducted at our facility from October 2012 to January 2018, and the study periods were divided into 4 phases comprising 16 months each. A multiple-choice questionnaire assessed participants' awareness of the following 13 pathogens of mother-to-child infections: cytomegalovirus (CMV), Toxoplasma gondii (T. gondii), hepatitis B virus, rubella virus, herpes simplex virus, parvovirus B19, hepatitis C virus, human immunodeficiency virus, human T cell leukemia virus type-1, measles virus, varicella-zoster virus, Chlamydia trachomatis, and Treponema pallidum. For the selected four pathogens (i.e., CMV, rubella virus, T. gondii, and parvovirus B19), the questionnaire also evaluated participants' knowledge of transmission routes, the most susceptible time of infection that could yield severe fetal disease during pregnancy, the maximum frequency of fetal infection in cases of maternal infection, and methods to prevent maternal infection. In total, 1433 pregnant Japanese women were included in this study. There was no secular change in awareness of the pathogens concerning mother-to-child infections over time, and we also clarified that the detailed knowledge of the four pathogens of typical mother-to-child infections did not improve. Since knowledge about methods to prevent maternal infection is still insufficient for all pathogens, further advocacy is required to prevent mother-to-child infections., Competing Interests: The authors have declared that no competing interests exist.

Background: COVID-19 may predispose pregnant women to higher risks of severe disease and poorer neonatal outcome. Psychological sequalae of this pandemic may pose a greater conundrum than its clinical aspects. It is currently unknown that how pregnant women cope with this global pandemic and its ramifications. The aims of the study are to understand the attitudes and precaution practices of non-infected pregnant women towards the COVID-19 outbreak in Singapore., Methods: An online cross-sectional survey of COVID-19 awareness among pregnant women attending antenatal clinics in Singapore was conducted. An internet link was provided to complete an online electronic survey on Google platform using a quick response (QR) code on mobile devices. The online survey consists of 34 questions that were categorized into 4 main sections, namely 1) social demographics 2) attitude on safe distancing measures 3) precaution practices and 4) perceptions of COVID-19. Multiple linear regression analysis was performed to examine women's precaution practices among six independent socio-demographic variables, including age, ethnicity, education, front-line jobs, history of miscarriage and type of antenatal clinic (general, high risk)., Results: A total of 167 survey responses were obtained over 8 weeks from April to June 2020. The majority of women were aged ≤35 years (76%, n = 127), were of Chinese ethnicity (55%, n = 91), attained tertiary education (62%, n = 104) and were not working as frontline staff (70%). Using multiple linear regression models, Malay ethnicity (vs. Chinese, β 0.24; 95% CI 0.04, 0.44) was associated with higher frequency of practicing social distancing. Malay women (β 0.48; 95% CI 0.16, 0.80) and those who worked as frontline staff (β 0.28; 95% CI 0.01, 0.56) sanitized their hands at higher frequencies. Age of ≥36 years (vs. ≤30 years, β 0.24; 95% CI 0.01, 0.46), Malay (vs. Chinese, β 0.27; 95% CI 0.06, 0.48) and Indian ethnicity (vs. Chinese, β 0.41; 95% CI 0.02, 0.80), and attendance at high-risk clinic (vs. general clinic, β 0.20; 95% CI 0.01, 0.39) were associated with higher frequency of staying-at-home., Conclusion: Social demographical factors including age > 36 years old, Malay ethnicity, employment in front line jobs and attendance at high-risk clinics are likely to influence the attitudes and precaution practices among pregnant women towards COVID-19 in Singapore. Knowledge gained from our cross-sectional online survey can better guide clinicians to communicate better with pregnant women. Hence, it is important for clinicians to render appropriate counselling and focused clarification on the effect of COVID-19 among pregnant women for psychological support and mental well being.

Background: COVID-19 is a novel type of the coronavirus family with an incompletely described clinical course. Little is known about the psychological aspects, particularly for vulnerable populations including pregnant women. Objectives: To understand the attitude, concerns, and knowledge of the non-infected pregnant women toward the COVID-19 outbreak in order to constitute base data for detailed counseling and to develop targeted messages. Patients and methods: This cross-sectional survey research presented analysis of prospectively collected data yielded at a single tertiary "Coronavirus Pandemic Hospital" referral center for a ten days period following the first confirmed death due to the COVID-19 pandemic in Turkey. Non-infected women with a confirmed pregnancy over 30th gestational week were consecutively included. A patient-reported non-validated questionnaire formed by the expert committee that includes 15 specific questions was used. Non-infected, pregnant women over 30th gestational week who applied to the outpatient clinic were consecutively included. A total of 213 women were enrolled, 37 were excluded: 7 for being in the first trimester, 3 were illiterate, and 27 were Syrian refugees having difficulties in translation. Results: A total of 172 pregnant women were included. Overall, four women refused to participate to the survey (1.9%). The mean age was 27.5 ± 5.3 years. Median gestational week and parity were 35 ± 11 weeks and 1 ± 2, respectively. Pregnant women were observed to trust the authorities (65%) and the healthcare staff (92.4%), and their respect was increased (82.5%) during the outbreak. Majority of the women (87.2%) comply with the self-quarantine rules. Half of the women (52%) reported that they felt vulnerable and predominantly were concerned (80%). Approximately one-third of the women constantly keep thinking that they may get infected (35.5%) or they might get infected during/following the delivery or their baby might get infected after being born (42%). Half of the women (50%) were reported that they either had no idea about or think the breastfeeding is not safe during the outbreak. About 45% of the women were confused or had doubts about if the mode of delivery may be affected by the pandemic. Greater part of the participants does not know if COVID-19 might cause birth defects (76%) or preterm birth (64.5%). Counseling flow keys helping pregnant women to overcome misleads, regarding the COVID-19 outbreak is proposed. Conclusions: Non-infected pregnant women with a viable pregnancy at near term were observed to have positive attitude and compliance toward the COVID-19 outbreak and frontline healthcare staff; increased concern and vulnerability; and restricted knowledge about the pregnancy-related outcomes. While the clinical evidence was growing rapidly, this data may guide obstetricians and midwives to perceive what accurate information should be provided to the pregnant women.

When male partners of pregnant women living with HIV do not participate in antenatal care, it decreases the uptake of prevention of mother-to-child transmission interventions, which increases the risk of HIV transmission to newborns. We evaluated the association of male partner involvement and vertical HIV transmission at 6 weeks along 4 constructs: antenatal clinic accompaniment, mother's awareness of partner HIV status, disclosure of mother's HIV status to partner, and couple testing. Thirty-three HIV-exposed infants with positive 6-week polymerase chain reaction (PCR) results were compared with 144 HIV-exposed infants with a negative PCR. Mothers of PCR-negative infants were 14 times more likely to have disclosed their HIV status to their partners (odds ratio [OR] = 14.1 [5.0-39.4]), to be aware of partner HIV status (OR = 0.2 [0.1-0.96]), and to have been accompanied by their male partners to the antenatal clinic (OR = 0.6 [0.5-0.9]). There is a need for male engagement in prevention of mother-to-child transmission programs.

Many investigations have shown the important role played by risk factors such as tobacco and alcohol and infectious agents (especially Rubella) in the development of congenital anomalies (CAs). Through the administration of a questionnaire, we evaluated the attitude of a population of pregnant women towards some risk factors in pregnancy (smoking and alcohol habit and risk of contracting one of TORCH agents). 14% of the women continued to smoke despite pregnancy; the majority of these were 34-35 years old, divorced, workers and with a high educational level. The 4.3% who identified as moderate drinkers; were mainly younger and married. Concerning the TORCH agents, it a high percentage were negative to the Rubella antibodies (62.8%). In order to improve the awareness of pregnant women on these risk factors, health education campaigns represent a public health cornerstone. Impact statement What is already known on this subject? Several investigations have shown an association between congenital anomalies (CAs) and various exogenous factors such as air pollutants, pesticides, metals, radiations and others present in the environmental matrices. Moreover, an important role is played by some risk factors linked to the lifestyles (i.e. tobacco and alcohol). What do the results of this study add? Our study shows that the awareness of the women about the importance of these risk factors is still rather poor, especially concerning the avoidable risks associated with smoke and alcohol and the preventable risk associated with rubella infection. What are the implications of these findings for clinical practice and/or further research? Our results highlight the importance of continuous health education both about the risk to smoke and drink during pregnancy and about the risk not to have had contract the rubella infection before the pregnancy. Particularly, about the latter issue, it appears necessary to increase the pre-conceptional diagnosis and, eventually, to vaccinate the women resulted negative in order to eliminate congenital rubella.

Introduction: Knowledge of HIV status in South Africa (SA) is reported to be 90% among people living with HIV. National level estimates could mask population-specific levels, which are critical to monitor program coverage and potential impact. Using data from the 2017 national antenatal sentinel survey, we assessed knowledge of HIV-positive status, initiation of antiretroviral therapy (ART), and socio-demographic characteristics associated with knowledge of HIV-positive status prior to the current pregnancy among women attending antenatal care., Methods: Between 1 October and 15 November 2017, a nationally representative sample of 32,716 pregnant women were enrolled from 1,595 public health facilities selected from all districts of SA. Data on age, gravidity, knowledge of HIV-positive status and ART initiation prior to pregnancy were extracted from medical records. A blood sample was collected from each woman regardless of prior knowledge of HIV status or ART history, and tested for HIV in the laboratory. All HIV-positive pregnant women enrolled in the survey were eligible for inclusion in the analysis. Multivariable survey logistic regression was used to examine factors associated with knowledge of HIV-positive status prior to the current pregnancy., Results: Of 10,065 eligible HIV-positive women, 60.8% (95% confidence interval (CI):59.9%-61.7%) knew their HIV status prior to the current pregnancy, of whom 91.1% (95% CI: 90.4%-91.7%) initiated ART prior to the current pregnancy. Knowledge of HIV-positive status was lower among adolescent girls and young women (15-24 years) (38.9%) and primigravid women (40.5%) compared with older women (35-49 years) (75.5%) and multigravid women (64.7%). In a multivariable analysis, significant effect modification was found between gravidity and age (P value = 0.047). Being in the age group 15-24 years compared to the age group 35-49 years decreased the odds of knowing HIV-positive status by 80% (adjusted odds ratio (AOR): 0.2, 95% CI:0.1-0.4) among primigravid women and by 60%(AOR: 0.4, 95% CI:0.3-0.4) among multigravid women., Conclusion: Knowledge of HIV-positive status prior to the current pregnancy fell short of the target of 90% among pregnant women living with HIV. This was especially low among adolescent girls and young women, highlighting the gap in youth friendly reproductive health and HIV testing services., Competing Interests: The authors have declared that no competing interests exist.

Background: The levels of insecticide-treated net use among pregnant women and uptake of intermittent preventive treatment in pregnancy, have been sub-optimal in Nigeria. Previous studies have reported positive correlations between knowledge, attitude and practice of malaria preventive measures. It has also been reported that information and motivation, act through a mediator (behavioural skills), to cause a health behaviour change. The aim of this study was as such to develop, implement, and assess the effects of a health educational intervention based on the information-motivation-behavioural skills (IMB) model on the levels of knowledge, motivation, and behavioural skills for ITN use and IPTp uptake among pregnant women in a hospital in north-eastern Nigeria., Methods: This was a randomized controlled parallel-group trial in which 372 antenatal care attendees were randomly assigned to either an intervention or control group after collecting baseline data using a structured questionnaire. The intervention group received a 4-h health education on malaria, guided by a module developed based on the IMB theory, while the control group received health education on breastfeeding for a similar duration and by the same facilitator. Follow-up data were subsequently collected at 2 months and at 4 months post-intervention using the same questionnaire. The generalized linear mixed models analysis was used to determine the between-group and within-group effects of the intervention. The intention-to-treat analysis was used after missing data had been replaced. This was followed by a sensitivity analysis, where the analyses were repeated without replacing the missing values., Results: The intervention was significant in achieving a 12.75% (p < 0.001), 8.55% (p < 0.001), and 6.350% (p < 0.001) higher total knowledge, motivation, and behavioural skills scores respectively, for the intervention group over the control group. The sensitivity analysis revealed no great differences in the effect sizes, even when missing data were not replaced., Conclusion: The intervention module was effective in improving knowledge, motivation and behavioural skills. It is as such recommended to be adopted and incorporated into the routine antenatal health education schedules. It is also recommended that booster doses of the module be given say 2 months after the first dose to sustain levels of motivation and behavioural skills. Trial registration Pan African Clinical Trial Registry, PACTR201610001823405. Registered 26 October 2016, http://www.pactr.org.

Background: Syphilis screening can be successfully integrated into antenatal clinics, and potentially avert significant morbidity and mortality to unborn infants. A minority of male partners report for testing and treatment, increasing the likelihood of reinfection. We conducted a qualitative study to understand factors influencing male partners to seek treatment after syphilis notification by their pregnant partners., Methods: A purposeful sample of 54 adults who participated in the STOP (Syphilis Treatment of Partners) study was stratified by gender (24 women, 30 male partners) and enrolled for in-depth interviews which were audio recorded, transcribed, and analyzed using the thematic approach., Results: The participants' median age (IQR) was 32 years (25-44), 87% were married, and 57.4% (31/74) had attained secondary education. Fourteen of 22 (63%) female participants reported that they sometimes experienced domestic violence. Male participant's knowledge of syphilis and their perception of their valued role as responsible fathers of an unborn baby facilitated return. Female's fear of partner's violence and poor communication between partners, were barriers against delivery of the notification forms to partners and subsequent treatment of partners. For men, fear of injection pain, perceptions of syphilis as a genetic disease and as a woman's problem, busy work schedules, poor access to good STD services, shared facilities with women in clinics, as well as HIV-related stigma were important barrier factors., Conclusions: The return to the clinic for treatment of male partners after partner notification by infected pregnant women, was low due to limited knowledge about syphilis, fear of painful injection, fears of domestic violence, lack of communication skills (individual characteristics) and syphilis disease characteristics such as signs and symptoms. This, combined with health services characteristics such as structural barriers that hinder male partner treatment, low access, low capacity, work/time challenges, inadequate laboratory services and low clinic personnel capacity; threatens efforts to eliminate mother-to-child infection of syphilis. Improved public messaging about syphilis, better services, legal and policy frameworks supporting STD notification and treatment in resource-constrained settings are needed for effective STD control., Trial Registration: Clinicaltrials.gov NCT02262390 ., Date Registered October 8 2014.

Objective: To identify proportion of and factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV in pregnant women attending antenatal care in Northern Ethiopia., Methods: A total of 416 pregnant women were interviewed between October 2012 and May 2013. Logistic regression analysis was used to identify factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV., Results: The proportion of pregnant women, who have comprehensive knowledge on prevention of mother-to-child transmission of HIV, was 52%. The odds of having comprehensive knowledge on prevention of mother-to-child transmission of HIV were higher among pregnant women who were younger (16 to 24 years old) (Adjusted Odds Ratio (AOR) = 2.95; 95%CI: 1.20, 7.26), urban residents (AOR = 2.45; 95%CI: 1.39, 4.32), attending secondary education and above (AOR = 4.43; 95%CI: 2.40, 8.20), employed (AOR = 4.99;95%CI: 2.45, 10.16), have five children or more (AOR = 9.34; 95%CI:3.78, 23.07), have favored attitude towards HIV positive living (AOR = 2.53; 95%CI: 1.43, 4.44) and have perceived susceptibility to HIV (AOR = 10.72; 95%CI: 3.90, 29.39)., Conclusion: The proportion of women who have comprehensive knowledge on prevention of mother-to-child transmission of HIV in this study setting was low. Measures which will escalate mother's knowledge on prevention of mother-to-child transmission of HIV should be emphasized. Efforts to improve mother's knowledge on prevention of mother-to-child transmission of HIV should target women who were older age (> = 35years), rural residents, unemployed, not attending formal education, primigravids, have no favored attitude towards HIV positive living and have not perceived susceptibility to HIV., Competing Interests: The authors have declared that no competing interests exist.

Preventing hepatitis B virus (HBV) mother-to-child transmission (MTCT) is the key to controlling the prevalence of chronic HBV infection. Adequate awareness of hepatitis B in hepatitis B s antigen (HBsAg) positive pregnant women may be helpful to reduce HBV MTCT.The aim of this study was to explore HBV seroprevalence among pregnant women and investigate the level of hepatitis B awareness among HBsAg positive pregnant women.HBV serum biomarkers were tested among pregnant women visiting Shengjing Hospital of China Medical University. HBsAg-positive pregnant women received a HBV DNA test and completed a questionnaire. The different HBV DNA loads were interpreted as follows: 20 to  < 2 × 10 IU/mL was low viral load, 2 × 10 to  < 2 × 10 IU/mL was intermediate viral load and ≥2 × 10 IU/mL was high viral load. The pregnant women with high viral load were treated with telbivudine (LdT). HBV DNA at different times was tested. The rate of HBV MTCT was confirmed at 28 weeks postpartum.HBsAg prevalence among pregnant women was 3.1% (441/14314). There was significant difference in comparing HBsAg prevalence in different age groups (χ = 13.86, P < .01). Among 441 HBsAg-positive pregnant women, 151 (34.2%) were hepatitis B e antigen (HBeAg) positive and 112 (25.4%) had high viral load. After 4 weeks of treatment, the average HBV DNA load of 66 cases with high viral load was (5.0 ± 0.8) log10 IU/mL. The average HBV DNA load at 4 weeks postpartum rebounded to (7.9 ± 1.0) log10 IU/mL, which was not significantly different from that at baseline (t = 1.23, P = .22). At 28 weeks postpartum, the rate of HBV MTCT in the treatment group was significantly lower than that in the observation group (0% vs 12.2%; P = .02). Only 23.4% of pregnant women knew their HBV status before gestation and 17.7% of pregnant women knew the HBV status before delivery. However, only 21.3% of pregnant women realized to need antiviral treatment to prevent MTCT.The pregnant women in Shenyang had a low HBsAg prevalence. Antiviral treatment for pregnant women with high viral load can effectively reduce the rate of HBV MTCT. HBV screening and education among HBsAg-positive pregnant women should be strengthened.

This study aimed to describe demographic and psychological characteristics among HIV-infected young women, and to identify knowledge, attitudes, and behaviors associated with conception, with the goal of informing interventions or programmatic decisions regarding preconception counseling methods for young women living with HIV. Behaviorally and perinatally HIV-infected young women (n = 34) were conveniently sampled in Miami, Florida. Participants were asked to complete measures of reproductive knowledge, attitudes toward conception, and risk behaviors, as well as measures of depression and cognitive functioning. Perinatally and behaviorally HIV-infected young women were very similar in important areas of health preconception practices such as conception-related health literacy and conception-related communication with providers. Behaviorally infected women, however, were somewhat more likely to have been pregnant in the past, and had greater knowledge of healthy contraception practices and family planning. Despite the difference among groups, both the perinatally and behaviorally acquired women demonstrated having adequate overall knowledge. Depression was higher and consistent with moderate depression among the behaviorally HIV-infected women in comparison to perinatally infected women. This study found that that despite adequate reproductive knowledge, most young HIV-infected women were not using contraception. Given the consequences of presentation of advanced HIV during pregnancy, the need for both treatment adherence and preconception counseling is essential. Results suggest that interventions or programmatic decisions regarding preconception counseling methods for young women living with HIV are necessary and potentially transferrable between populations., Competing Interests: statement: No potential conflict of interest was reported by the authors.

Background: Over 2 billion people are infected with Hepatitis B virus (HBV) and about 240 million are chronic carriers of the virus. Chronic HBV infection is an important cause of liver cancer. The infectivity of HBV is hundred times higher than the HIV virus yet it receives comparatively little attention in public health. The study assessed knowledge and awareness of HBV among pregnant women in the Kintampo Municipality of Ghana., Methods: A cross-sectional survey was conducted among pregnant women attending antenatal clinic in two facilities between September 2010 and November 2010. We performed analysis to determine factors associated with hepatitis B awareness., Results: Forty-one percent of the 504 women were aware of hepatitis B viral infection, 33.5% of the women were able to correctly mention the transmission routes of Hepatitis B. The radio was the most (42%) mentioned source of information on HBV and the least source of information were places of worship (2.7%).After adjusting for other factors, level of education; SSS/SHS and above OR=4.2, P<00.1, 95% CI (2.5, 7.0) and occupation (Civil servant/Student); OR= 3.8, P00.1, 95% CI (1.7, 8.5) were the important predictors of Hepatitis B awareness., Conclusion: There is a low level of knowledge and awareness of HBV among pregnant women in this municipality. This could potentially hamper effective HBV prevention and control in Ghana. Education on hepatitis B need to be included in health promotion activities., Funding: The study was funded by KHRC Director's small grant Initiative., Competing Interests: Conflicts of Interest: None declared

Background: Advances in diagnostic and therapeutic modalities for congenital cytomegalovirus (CMV) infection have generated a mounting interest in identifying mothers susceptible to CMV. The objectives of this study were to evaluate the prevalence and socio-demographic determinants of CMV susceptibility and CMV awareness, among pregnant women, in Montreal, Quebec., Methods: Between April and December 2012, women delivering at Centre Hospitalier Universitaire Sainte Justine were recruited for the study. Stored serum from the first trimester of pregnancy was tested for CMV IgG. Knowledge about CMV and socio-demographic characteristics were collected via standardized questionnaire., Results: Four hundred and ninety one women were enrolled in the study. Overall, 225 mothers (46%) were seronegative for CMV, and 85% (n = 415) were unaware of CMV or the associated risks in pregnancy. Significant risk factors for CMV seronegative status included Canadian vs. foreign born (aOR 6.88, 95% CI 4.33-10.94), and high vs. low family income (aOR 4.68, 95% CI 2.09-10.48). Maternal employment status was the only significant predictor of CMV unawareness, with unemployed mothers at the highest risk (aOR 85.6, 95% CI 17.3-421.3)., Conclusions: Nearly half of pregnant women studied were at risk of primary infection, and yet, the majority was unaware of potential risks associated with CMV. Canadian born mothers and those with a high socioeconomic status were more likely to be CMV seronegative. Increased education about CMV infection, through public health interventions and obstetrician/pediatric counseling, is needed for all pregnant women.

Background: Malaria is the leading cause of illness and death in Papua New Guinea (PNG). Infection during pregnancy with falciparum or vivax malaria, as occurs in PNG, has health implications for mother and child, causing complications such as maternal anemia, low birth weight and miscarriage. This article explores knowledge, attitudes and practices concerning malaria during pregnancy and it's prevention in Madang, PNG, a high prevalence area., Methods: As part of a qualitative study in Madang, exploring MiP, participatory techniques (free-listing and sorting) were conducted along with focus group discussions, in-depth interviews (with pregnant women, health staff and other community members) and observations in the local community and health facilities., Results: The main themes explored were attitudes towards and knowledge of MiP, its risks, and prevention. Although there was a general awareness of the term "malaria", it was often conflated with general sickness or with pregnancy-related symptoms. Moreover, many preventive methods for MiP were related to practices of general healthy living. Indeed, varied messages from health staff about the risks of MiP were observed. In addition to ideas about the seriousness and risk of MiP, other factors influenced the uptake of interventions: availability and perceived comfort of sleeping under insecticide-treated mosquito nets were important determinants of usage, and women's heavy workload influenced Chloroquine adherence., Conclusion: The non-specific symptoms of MiP and its resultant conflation with symptoms of pregnancy that are perceived as normal have implications for MiP prevention and control. However, in Madang, PNG, this was compounded by the inadequacy of health staff's message about MiP.

Infant feeding raises unique concerns for mothers living with HIV in Canada, where they are recommended to avoid breastfeeding yet live in a social context of "breast is best." In narrative interviews with HIV-positive mothers from Ontario, Canada, a range of feelings regarding not breastfeeding was expressed, balancing feelings of loss and self-blame with the view of responsibility and "good mothering" under the current Canadian guidelines. Acknowledging responsibility to put their child's health first, participants revealed that their choices were influenced by variations in social and cultural norms, messaging, and guidelines regarding breastfeeding across geographical contexts. This qualitative study raises key questions about the impact of breastfeeding messaging and guidelines for HIV-positive women in Canada.

Fertility decisions among people living with HIV/AIDS (PLWHA) are complicated by disease progression, the health of their existing children and possible antiretroviral therapy (ART) use, among other factors. Using a sample of HIV-positive women (n = 353) and men (n = 299) from Nigeria and Zambia and their healthcare providers (n = 179), we examined attitudes towards childbearing and abortion by HIV-positive women. To measure childbearing and abortion attitudes, we used individual indicators and a composite measure (an index). Support for an HIV-positive woman to have a child was greatest if she was nulliparous or if her desire to have a child was not conditioned on parity and lowest if she already had an HIV-positive child. Such support was found to be lower among HIV-positive women than among HIV-positive men, both of which were lower than reported support from their healthcare providers. There was wider variation in support for abortion depending on the measure than there was for support for childbearing. Half of all respondents indicated no or low support for abortion on the index measure while between 2 and 4 in 10 respondents were supportive of HIV-positive women being able to terminate a pregnancy. The overall low levels of support for abortion indicate that most respondents did not see HIV as a medical condition which justifies abortion. Respondents in Nigeria and those who live in urban areas were more likely to support HIV-positive women's childbearing. About a fifth of HIV-positive respondents reported being counselled to end childbearing after their diagnosis. In summary, respondents from both Nigeria and Zambia demonstrate tempered support of (continued) childbearing among HIV-positive women while anti-abortion attitudes remain strong. Access to ART did not impart a strong effect on these attitudes. Therefore, pronatalist attitudes remain in place in the face of HIV infection.

Knowledge of pregnant women on the three periods of mother-to-child transmission (MTCT) of HIV has implication for child HIV acquisition. This study aims to assess the knowledge of pregnant women on mother-to-child transmission of HIV and to identify associated factors in Meket district, northeast Ethiopia. Logistic regression models were fitted to identify associated factors. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine the presence and strength of association. About one-fifth (19%) of women were knowledgeable on mother-to-child transmission of HIV (95% CI: 15.5%, 22.4%). Being urban resident (AOR: 2.69, 95% CI: 1.48, 4.87), having primary education (AOR: 2.41, 95% CI: 1.03, 5.60), reporting receiving information on HIV from health care providers (AOR: 3.24, 95% CI: 1.53, 6.83), having discussion with partner about mother-to-child transmission of HIV (AOR: 2.64, 95% CI: 1.59, 4.39), and attending antenatal care (AOR: 5.80, 95% CI: 2.63, 12.77) were positively associated with increased maternal knowledge of mother-to-child transmission of HIV. Knowledge of mother-to-child transmission of HIV among pregnant women was low. Providing information, especially for rural women and their partners, is highly recommended.

This study assessed the level of knowledge and misconceptions about HIV/AIDS transmission and prevention among women. Using a semi-structured pretested questionnaire we obtained relevant data from 420 respondents in five randomly selected antenatal clinics (ANCs) in Gwagwalada Area Council (GAC) of Abuja, Nigeria. Knowledge about the existence of HIV/AIDS was high (92.8%). Only 52.1% knew the cause of AIDS and 58.6% were aware that AIDS had no cure. About twenty percent of respondents believed that breast-milk could not transmit HIV and 27.9% were unaware that condom protects against HIV. Only 33.3% were aware that HIV infected persons may look and feel healthy. Mothers with at least secondary level education had significantly higher knowledge scores on HIV/AIDS transmission (X2 = 14.8, p = 0.01) than less educated mothers and less educated mothers were more likely to relate HIV infection to past misdeeds (X2 = 13.6, p = 0.01). Significant misconception concerning HIV transmission existed in the study population. More community outreach programmes to intensify HIV education and counseling in GAC is required.

Although stigma towards HIV-positive women for both continuing and terminating a pregnancy has been documented, to date few studies have examined relative stigma towards one outcome versus the other. This study seeks to describe community attitudes towards each of two possible elective outcomes of an HIV-positive woman's pregnancy - induced abortion or birth - to determine which garners more stigma and document characteristics of community members associated with stigmatising attitudes towards each outcome. Data come from community-based interviews with reproductive-aged men and women, 2401 in Zambia and 2452 in Nigeria. Bivariate and multivariate analyses revealed that respondents from both countries overwhelmingly favoured continued childbearing for HIV-positive pregnant women, but support for induced abortion was slightly higher in scenarios in which anti-retroviral therapy (ART) was unavailable. Zambian respondents held more stigmatising attitudes towards abortion for HIV-positive women than did Nigerian respondents. Women held more stigmatising attitudes towards abortion for HIV-positive women than men, particularly in Zambia. From a sexual and reproductive health and rights perspective, efforts to assist HIV-positive women in preventing unintended pregnancy and to support them in their pregnancy decisions when they do become pregnant should be encouraged in order to combat the social stigma documented in this paper.

This study aimed to document whether food insecurity was associated with beliefs and attitudes towards exclusive breastfeeding (EBF) among urban Kenyan women. We conducted structured interviews with 75 human immunodeficiency virus (HIV)-affected and 75 HIV-status unknown, low-income women who were either pregnant or with a child ≤24 months and residing in Nakuru, Kenya to generate categorical and open-ended responses on knowledge, attitudes and beliefs towards EBF and food insecurity. We facilitated six focus group discussions (FGD) with HIV-affected and HIV-status unknown mothers (n = 50 women) to assess barriers and facilitators to EBF. Of 148 women with complete interview data, 77% were moderately or severely food insecure (FIS). Women in FIS households had significantly greater odds of believing that breast milk would be insufficient for 6 months [odds ratio (OR), 2.6; 95% confidence interval (95% CI), 1.0, 6.8], that women who EBF for 6 months would experience health or social problems (OR, 2.7; 95% CI, 1.0, 7.3), that women need adequate food to support EBF for 6 months (OR, 2.6; 95% CI, 1.0, 6.7) and that they themselves would be unable to follow a counsellor's advice to EBF for 6 months (OR, 3.2; 95% CI, 1.3, 8.3). Qualitative analysis of interview and FGD transcripts indicated that the maternal experience of hunger contributes to perceived milk insufficiency, anxiety about infant hunger and a perception that access to adequate food is necessary for successful breastfeeding. The lived experience of food insecurity among a sample of low-income, commonly FIS, urban Kenyan women reduces their capacity to implement at least one key recommended infant feeding practices, that of EBF for 6 months., (© 2010 Blackwell Publishing Ltd.)

Several authors have shown that women's uptake of antenatal HIV testing is influenced by fear of their partners' reactions. We conducted a qualitative study with 40 Ugandan men to examine their attitudes toward their partners' participation in antenatal HIV testing. Most men believed women should consult their husbands prior to HIV testing to avoid negative consequences and facilitate disclosure. When women tested during routine antenatal care, however, the need to obtain permission was considered less important. These findings lend support to the practice of routine antenatal HIV testing as an acceptable way for women to test independently of their partners.

The objective of this study was to describe attitudes, opinions, and perceived health needs of HIV-infected women in the United States. In this cross-sectional study, women were invited to participate in the Women Living Positive survey, a structured interview instrument with 45 questions. Collected data were deidentified and the margin of error was calculated as four percentage points. Incoming toll-free phone interviews were conducted from December 21, 2006, through March 14, 2007 among subjects recruited from a U.S. national network of AIDS counseling centers. Seven hundred HIV-infected women (43% African American, 28.5% Hispanic, 28.5% Caucasian; median age, 42.5 years) receiving combination antiretroviral therapy for 3 years or more replied to recruitment flyers. Overall, 55% of survey participants had never discussed gender-specific HIV treatment issues with their HIV care providers. Of the 45% who did discuss these issues, almost all (96%) were satisfied. On average, one-third of the women had seen three or more providers since beginning HIV treatment; 43% indicated they had switched providers because of communication issues. Among women who had been or were pregnant at the time of the survey (n=159), more than half (57%) had not had pre-pregnancy discussions with their HIV provider about the most appropriate HIV regimens for women attempting to become pregnant. Significant communication gaps exist between HIV-infected women and their providers when discussing gender-specific treatment issues. These data highlight a need for U.S. health care providers to incorporate discussion of gender-specific issues, including preconception and reproductive counseling, into management strategies for HIV-infected women.

Counseling services is an important component of National AIDS Control Program which aims at creating awareness and promoting changes in reducing high risk behavior against HIV/AIDS. Pregnant women attending antenatal clinics are being counseled about HIV/AIDS under prevention of parent to child transmission (PPTCT) program. The objective of this study was to assess (KABP) regarding HIV/AIDS among pregnant women attending PPTCT program before and after counseling at Lok Nayak Hospital, New Delhi. A Quasi-experimental study was conducted. Data was collected by interviewing 600 pregnant women attending ANC clinic during May 2006 to May 2007 using a pre-test and post-test interview schedule. About 69.2% of the pregnant women had heard about AIDS before the counseling. Knowledge regarding mother to child transmission of HIV was 53.5%. 38.2% knew that mother to child transmission can be reduced by drugs. The knowledge of pregnant women about AIDS was significantly different in pre-test (mean score = 15.3) and post test (mean score = 35.6) (P < 0.0001). Attitude of study participants towards people living with HIV/AIDS (PLWHA) indicated that individuals with HIV should be allowed to work (79.9%) and all commercial sex workers should compulsorily be tested for HIV (55.1%). There was significant difference between in pre-test and post-test attitude about PLWHA and HIV testing (p < 0.0001). The condom use among the study participants significantly improved after counseling (1.2% in pre-test and 58.6% after counseling) (p < 0.0001). Counseling services were effective in increasing knowledge and changes in attitude and behavior among pregnant women and the efforts needs to be sustained.

Background: Several studies support the need for effective interventions to reduce HIV transmission risk behaviors among people living with HIV/AIDS (PLWHAs)., Design: Cross-sectional nationally representative demographic health survey of Kenya (2003) and Malawi (2004-2005) that included HIV testing for consenting adults., Methods: We analyzed demographic health survey data for awareness of HIV status and sexual behaviors of PLWHAs (Kenya: 412; Malawi: 664). The analysis was adjusted (weighted) for the design of the survey and the results are nationally representative., Findings: Eighty-four percent of PLWHAs in Kenya and 86% in Malawi had sex in the past 12 months and in each country, 10% reported using condoms at last intercourse. Among sexually active PLWHAs, 86% in Kenya and 96% in Malawi reported their spouse or cohabiting partner as their most recent partner. In multivariate logistic regression models, married or cohabiting PLWHAs were significantly more likely to be sexually active and less likely to use condoms. Over 80% of PLWHAs were unaware of their HIV status. Of HIV-infected women, nearly three-quarters did not want more children either within the next 2 years or ever, but 32% in Kenya and 20% in Malawi were using contraception., Interpretation: In 2003-2005, majority of PLWHAs in Kenya and Malawi were unaware of their HIV status and were sexually active, especially married or cohabiting PLWHAs. Of HIV-infected women not wanting more children, few used contraception. HIV testing should be expanded, prevention programs should target married or cohabiting couples and family planning services should be integrated with HIV services.

Overall HIV test coverage among pregnant women in Brazil is 62%, but only 41% in northeastern Brazil. We aimed to identify risk factors for unawareness of HIV status among pregnant women and determine test coverage up to 14th week of pregnancy. We conducted a case-control study in a reference maternity hospital for high-risk pregnancy in Recife, where 485 puerperae were interviewed about their knowledge of results of HIV testing, biological, sociodemographic and health-care data. Cases were those who were not aware of their HIV status and controls were those who were. Only 21.65% stated that they were unaware of their HIV status during pregnancy (78.35% coverage); however, test results were recorded on an antenatal card in only 48.35%. Only 22% received the result by the 14th week of pregnancy. Unawareness was associated with low schooling (odds ratio [OR] = 2.92; P = 0.006); living outside the state capital's metropolitan region (OR = 4.11; P = 0.001); test performed in the third trimester (OR = 11.6; P = 0.000); and lack of counselling (OR = 2.31; P = 0.022) in multivariate analysis. In conclusion, there has been a considerable delay in having an HIV test. Conflict of Information obtained by interview and that on the antenatal card raises questions about deficiencies in antenatal care or lack of comprehension about the HIV test.

Objective: We sought to explore optimism/pessimism, knowledge of HIV, and attitudes toward HIV screening and treatment among Ghanaian pregnant women., Method: Pregnant women in Accra, Ghana, completed a self-administered questionnaire including the Life Orientation Test-Revised (LOT-R, an optimism/pessimism measure), an HIV knowledge and screening attitudes questionnaire, the Short Form 12 (SF-12, a measure of health-related quality of life [HRQOL]), and a demographic questionnaire. Data were analyzed using t-tests, ANOVA, correlations, and the chi2 test., Results: There were 101 participants; 28% were nulliparous. Mean age was 29.7 years, and mean week of gestation was 31.8. All women had heard of AIDS, 27.7% had been tested for HIV before this pregnancy, 46.5% had been tested during this pregnancy, and 59.4% of the sample had ever been tested for HIV. Of those not tested during this pregnancy, 64.2% were willing to be tested. Of all respondents, 89% said they would get tested if antiretroviral drugs (ARVs) were readily available and might prevent maternal-to-child transmission. Neither optimism/pessimism nor HRQOL was associated with attitudes toward HIV screening. Optimism was negatively correlated with HIV knowledge (p = .001) and was positively correlated with having never been tested before this pregnancy (p = .007)., Conclusion: The relationship between optimism/pessimism and HIV knowledge and screening behavior is worthy of further study using larger samples and objective measures of testing beyond self-report.

Background: Stigmatization and discrimination of people living with HIV/AIDS has a negative impact on the global efforts to control the HIV/AIDS pandemic. Due to fear of stigmatization and discrimination, many people are reluctant to undergo voluntary counseling and testing, infected individuals are often unwilling to disclose their status and some of them still engage in high-risk behaviours leading to increased transmission of the virus., Study Design and Setting: A study of the attitudes to people living with HIV/AIDS was carried out among antenatal clinic attendees at the University of Uyo Teaching Hospital with the aim of developing site-specific information and counseling interventions to reduce stigmatization and discrimination of people living with HIV/AIDS. Information was elicited from 265 randomly selected women who booked for antenatal care between September and December 2005 with the use of a self-administered questionnaire., Results: 263 questionnaires were duly completed and analyzed. The mean age of the respondents was 27 ± 5.1 years, majority of them (52.1%) were either unemployed or unskilled workers and 42.9% of them had tertiary education. Awareness and knowledge of HIV/ AIDS was high, (95.8%) and (86.7%) respectively. Majority of the respondents (55.6%) were also assessed as having a positive attitude to people living with HIV/AIDS (PLWHA). There was a statistically significant association between good knowledge of HIV/AIDS and a positive attitude to PLWHA (P=0.000) and a high educational status with a positive attitude to PLWHA (P=0.009)., Conclusion: combating stigma and discrimination is an important process in controlling the epidemic. Specific information and counseling interventions aimed at dispelling misconceptions about HIV/AIDS should be reinforced.

This article reports the findings of a qualitative research study carried out in Kabarole district, western Uganda. Knowledge of and perceptions about HIV/AIDS and pregnancy and how both relate to one another were elucidated from eight focus-group discussions with 38 female and 32 male secondary students from four different schools. Widespread misinformation and misconceptions about contraceptives still exist as previously found in this area. There was a serious gap in knowledge and understanding of 'dual protection' against sexually transmitted diseases, including HIV/AIDS, and against pregnancy. Fertility was very highly valued, and many girls stated that they would want a child even if they were HIV-positive. Responses of girls showed that they were quite assertive in making decisions to use contraceptives. The reasons for students not being able to understand the interconnectedness of sexually transmitted diseases and pregnancy may lie in the fragmented fashion in which relevant health education is delivered through two separate programmes.

Objective: To evaluate the awareness and knowledge of mother-to-child transmission of HIV and its prevention among pregnant women attending the antenatal clinic of a federal medical center in Nigeria., Methodology: Valid and reliable questionnaires were interviewer administered to pregnant women at antenatal booking during the study period, prior to being counseled on HIV/AIDS., Results: All respondents were aware of HIV/AIDS. The main sources of information included posters/billboards (37%), radio (36%), television (28%) and health workers (34%). The majority (90%) of the respondents were aware that HIV/AIDS can coexist with pregnancy, but only 68% were aware of mother-to-child transmission. Transplacental route, vaginal delivery and breastfeeding were identified as routes of transmission from mother to child by 65%, 38% and 52% of respondents, respectively. Caesarean section was believed to be a route of transmission by 43% of respondents, but only 3% identified caesarean section as a method of prevention of mother-to-child transmission., Conclusion: Though the level of awareness of HIV/AIDS among women attending our antenatal clinic is high, the level of knowledge about mother-to-child transmission is inadequate. There is a need for adequate counseling and education about HIV/AIDS and mother-to-child transmission in antenatal clinics and also through public campaign media.

The rate of HIV seroprevalence in Nigeria is troublesome because it is one of the highest prevalence rates worldwide. As in most developing countries, vertical transmission from mother to child accounts for most of the HIV infections in Nigerian children. The purpose of this study was to determine the awareness, attitudes, and beliefs of pregnant Nigerian women toward voluntary counseling and testing (VCT) for HIV. Two hundred forty pregnant women in Awka, Nigeria, completed questionnaires aimed at determining their willingness to accept or reject VCT. Furthermore, participants where questioned about their knowledge of HIV infection, routes of transmission, and treatment options. The majority of the women (87%) approved of VCT; of those who approved, 93% were aware that VCT could reduce the risk of transmission of HIV to their babies. All respondents who accepted VCT were willing to be tested if results remained confidential and 89% would accept if they were tested simultaneously with their partners. 69% of the women who refused VCT attribute their refusal to the social and cultural stigmatization associated with HIV. Overall, the acceptance of VCT appears to depend on the understanding that VCT has proven benefits for the unborn child. Sociocultural factors such as stigmatization of HIV-infected individuals appears to be the major barrier toward widespread acceptance of VCT in Nigeria, thus the development of innovative health education strategies is essential for providing women with information regarding the benefits of VCT and other means of prevention of mother-to-child transmission of HIV (PMTCT).

This paper describes the experiences and concerns of women participating in a short-term AZT intervention feasibility study to prevent mother-to-child HIV transmission at three sites in India. The study used qualitative methods to examine the experiences of 31 women during late pregnancy, delivery and at post-natal visits. It also elicited the perspectives of 19 healthcare providers. Frequent visits required during late-pregnancy and the post-natal period presented concerns for the women in the study. Women's understanding of the long-term implications of participating in the intervention study was poor, and living with uncertainty about the HIV status of the newborn was a major concern. The provision of psychosocial support is essential in future intervention studies and should be incorporated on an ongoing basis. Networking with women-centred support groups may be helpful in enabling women to gain the long-term benefits of this type of intervention.

Objective: To understand how the risk of vertical HIV transmission is perceived and interpreted by people living with HIV/AIDS, when making decisions regarding reproductive health., Methods: This was a qualitative study carried out at three municipal health clinics specializing in STD/AIDS, in the city of São Paulo. Semi-structured thematic interviews were conducted with eight patients (male and female), from July to December 2001. The interviewees were key informants and either they or their partners were seropositive. All of them were aged 18 or over and had been living with their partners for at least one year., Results: Among the motivations for having children, those related to the partner's expectations were highlighted, especially as a form of "recompense" for their actions. The risk of vertical transmission was used by health professionals both for discouraging pregnancy and for giving guidance on transmission prophylaxis. However, reproductive issues were not voiced at the health clinics, either by the patients or by the healthcare providers., Conclusions: Attention should be directed not only towards controlling the infection, but also most importantly towards the wellbeing of people living with HIV/AIDS. There is a need to clarify the different points of view of users and professionals in order to achieve the most effective and appropriate solution for each specific caregiving situation.

Objectives: The aim of the study was to assess the knowledge, attitude and practices of pregnant women towards malaria and their association with malaria morbidity., Methods: Cross-sectional malaria survey of 1432 pregnant women attending six health centres, each of them situated in a specific health district in Rwanda from September to October 2002., Results: The overall prevalence of malaria infection was 13.6% and all infections but two were caused by Plasmodium falciparum. The six health districts were significantly different in terms of malaria prevalence, which varied between 11.5% and 15.4% in four and was <5% in the other two districts. The prevalence of anaemia and splenomegaly mirrored that of malaria infection. In three districts, the prevalence of infection was significantly higher in primigravidae than in secundigravidae and multigravidae (P = 0.01), while in two others it did not vary with parity. Bed net use was low - only 13.1% of the women had at least one bed net at home and 8.3% of them slept under it - and significantly different between districts. Most women knew that malaria might have serious consequences for their pregnancy and that insecticide-treated bed nets are useful for malaria prevention. However, the bed net market price [1525 Rwandan Francs (RFr), approximately 1.6] was much higher than that considered as affordable and acceptable (389 RFr, approximately 0.3)., Conclusion: Malaria in pregnancy is a major problem in Rwanda, even in the districts of low transmission. Bed net use among pregnant women is low. The option of providing free insecticide-treated bed nets to pregnant women should be explored and possibly implemented; it could rapidly increase bed net use and earlier attendance to antenatal clinics with clear benefits for the women's health.

Background: With the increase in HIV infection among childbearing aged women in Hong Kong, health department policy-makers are considering the implementation of antenatal HIV screening to identify infected mothers. However, little is known about women's understanding of HIV/AIDS, and their attitudes towards HIV screening., Aim: The aim of this study was to explore pregnant women's knowledge about HIV/AIDS, their perceptions of risk, risk behaviour and management, and their attitudes towards HIV screening., Methods: A cross-sectional study was carried out, and all Chinese pregnant women who attended an antenatal clinic of a regional hospital in Hong Kong in the month of December 2000 were invited to complete a questionnaire., Findings: Hong Kong pregnant women had fairly good general knowledge of HIV/AIDS (mean score = 4.8/6), but were less knowledgeable on specific mother-to-child HIV transmission (mean score = 3.6/6). There were statistically significant differences between those with different levels of education (chi2 = 19.81; P < 0.001) and between Hong Kong born residents and immigrants from the Chinese mainland (z = -4.03; P < 0.001). Over a third (36.7%) of all pregnant women perceived a risk of contracting HIV. If HIV infection were suspected, over 70% would have HIV screening together with their spouse. If HIV was confirmed, 24% would terminate the pregnancy. As many as 78.5% and 72.8% of women believed that HIV screening should be carried out before marriage and pregnancy respectively. Only 4.7% would choose universal opt-out antenatal HIV testing., Recommendations: Health educators should provide tailored-made education programmes for women at risk, particularly those at lower education levels and those who have come from the Chinese mainland, to enhance their knowledge about mother-to-child HIV transmission, and to promote awareness of safe sex. Health policy-makers should consider the possibility of providing pre-marriage and pre-pregnancy HIV screening for women.

Unlabelled: This paper describes the results of a study exploring the attitudes of women attending maternity clinics to voluntary counselling and testing during pregnancy in rural areas in south-west Uganda. It was a qualitative study using focus group discussions (FGDs). Twenty-four FGDs were carried out with 208 women attending maternity clinics in three sites in rural south-west Uganda. The FGDs were all recorded and transcribed, and analysed using standard computer-based qualitative techniques. Almost all women were willing in principle to take an HIV test in the event of pregnancy, and to reveal their HIV status to maternity staff. They were anxious, however, about confidentiality, and there was a widespread fear that maternity staff might refuse to assist them when the time came to deliver if their status were known. This applied more to traditional birth attendants than to biomedical health staff. There were also rumours about medical staff intentionally killing HIV-positive patients in order to stem the spread of the epidemic. Women were concerned that if their husbands found out they were HIV-positive they would be blamed and separation or domestic violence might result., In Conclusion: although VCT during pregnancy is acceptable in principle, much will need to be done to ensure confidentiality and allay women's fears of stigmatisation and discrimination during delivery. Community sensitisation will be necessary and male partners will have to be involved if interventions are to be acceptable.

To explore women's experiences and beliefs concerning zidovudine (AZT) therapy during pregnancy, short-answer and open-ended questions were asked of 322 human immunodeficiency virus (HIV)-infected women at increased risk for pregnancy. Specifically, we examined what women believed they had been told concerning AZT therapy during pregnancy by health care professionals and peers, experiences with taking AZT, how effective they believed AZT therapy to be, and if they would take AZT if they became pregnant. Women in the study were predominately African American (88%), single (79%), with a mean age of 32 years, and had annual incomes less than $10,000 (64%). Although 81.4% of the women had been told to take antiretrovirals, only 69.1% of the women were actually taking HIV-related medicines. Almost three-fourths of the women (70.8%) reported being told that taking AZT during pregnancy would reduce perinatal transmission. Women reported the most frequent reason for their stopping AZT was its side effects. When women who were not presently taking AZT were asked what would make them consider taking it, they most frequently said they would begin AZT if their health deteriorated or based on the advice of health care professionals. A small group of women said nothing would make them take AZT-type medications. More than one-half of the women said they felt AZT was effective in preventing perinatal HIV transmission. However, almost 20% of the women reported believing that their health care provider would not be positive about their taking AZT during pregnancy. Significant relationships were found between intent to take AZT if becoming pregnant and specific AZT-related beliefs and experiences.

HIV is a growing epidemic among women in the United States. This study seeks to determine if knowledge of HIV infection and of the benefits of prenatal zidovudine (ZDV) to decrease vertical HIV transmission is related to decisions about pregnancy planning, contraceptive and condom use, and pregnancy termination among noninjection drug using (IDU) women with HIV. Eighty-two HIV-infected women were interviewed about their pregnancy decisions, contraceptive and condom use, and pregnancy outcome. Data was verified by structured chart review where available. Awareness of HIV infection or knowledge of the benefits of prenatal ZDV use did not significantly influence pregnancy planning, contraceptive choice, use of contraception, or consideration of pregnancy termination. Condom use was extremely low (14.6% consistent use), the majority of pregnancies (68.0%) were unplanned, contraceptive use was low (50.9%), and few pregnancies were terminated (6.3%). Women on Medicaid were significantly less likely than women with private or no insurance to terminate their pregnancy (2/20, 10% vs. 3/5, 60%, p = 0.04, two-tailed Fisher's exact test). Most women (70.0%) reported the most important reason for carrying the pregnancy to term was the desire for a child. In conclusion, among women in this non-IDU, Midwestern cohort, knowledge of HIV infection was not associated with decisions to plan a pregnancy, use contraception if not planning pregnancy, or terminate an unplanned pregnancy.

Recent use of zidovudine (ZDV) to reduce vertical transmission of HIV disease in newborns has demonstrated varied, but in some studies, dramatic results, with reports of reduction from approximately 8% to 25%. With this potential of efficacy in saving lives, knowledge of access to prenatal care for HIV-infected pregnant women is urgent. The current study used face-to-face and phone survey methods and employed a 77-item questionnaire to assess barriers to prenatal care in two groups of HIV-positive and HIV-negative women (n = 106). All participants had a child(ren) under 4 years of age and were currently enrolled in a primary care or family HIV clinic. Results showed that HIV-positive women had specific concerns regarding access of perinatal care that included disclosure and fear of anger from health care providers. Barriers such as transportation, insurance and child care, among others, were not predictive of the level of prenatal care received, but results may be biased by the small number of women who had not received adequate care and the general selection process from women who were currently attending clinics. A high level of prenatal care was recorded across both cohorts. Misconceptions about vertical transmission and ZDV efficacy were demonstrated, including that more than 80% of all participants stated there was a greater than 50% chance of a pregnant untreated HIV-positive woman transmitting the virus; the documented transmission rate for untreated birth mothers is 20% to 25%. In addition, HIV-negative women showed little knowledge about vertical transmission and the use of ZDV, putting this group at risk in the future. Better educational methods to more women about perinatal HIV transmission and ADV could be imperative in significantly improving reduction of vertical transmission.

Since 1991, the French public health ministry has recommended that human immunodeficiency virus (HIV) testing be offered to all pregnant women. This study was undertaken to determine whether this recommendation is followed independently of a woman's ethnicity. It is based on a 1992 survey regarding knowledge, attitudes, beliefs, and practices on HIV infection and testing among pregnant women in southeastern France. Survey results revealed that North-African women (n = 207) were more likely to have a low socioeconomic and educational level, receive their health care at public health institutions, and be less knowledgeable about HIV transmission than French women (n = 2234). They were also more likely to have been tested for HIV without their knowing it and less likely to perceive themselves as being at risk. Consent to undergo HIV testing during pregnancy was dependent on their North-African origin after controlling for significant covariates. These results indicate that routine prenatal screening appears insufficient to ensure adequate HIV testing and counseling of women of ethnic minorities. The development of HIV prevention programs that are cultural-specific and that aim at increasing physicians' compliance with the official recommendation is needed.

The object of this study supported by the French Agency for AIDs Research (ANRS) was to assess knowledge and attitudes of pregnant women towards HIV infection and testing, and to compare them according to the outcome of the pregnancy (elective abortion vs delivery). Between March 22 and April 26, 1992, all women ending their pregnancy and attending one of the 72 medical centres located in South-Eastern France were asked to complete an anonymous questionnaire (n = 4303). 3,854 (89.6%) responded: 2,825 women at delivery (WD) and 764 who chose an elective abortion (WA). 61.7% of WD and 24.1% of WA declared having been tested for HIV during pregnancy (p < 0.001). Among women who reported not having been HIV tested, very few did so because they refused the test (1.7% among WD and 1.4% among WA-NS). Prior HIV testing was less frequent among WA than among WD (45.8% vs 58.8%--p < 0.001). 2.8% of women tested during prenatal care and 20% in the context of abortion did not know the result of their test (p < 0.001). Knowledge about HIV transmission declared by WD did not differ significantly from that declared by WA. However, risky behaviours were more frequent among WA than among WD (38.9% vs 17.7%--p < 0.001). This research shows that French screening HIV policy in the context of pregnancy remains mainly motivated by foetal concerns. Although women who abort voluntarily report risky behaviours more frequently, the opportunity of information and counselling towards them is relatively neglected in comparison with women who deliver.

The condom is widely recommended as the principal method for preventing HIV transmission, but such advice obviously does not apply to women who are seeking to become pregnant. In this sense, 'safer sex' is incompatible with reproduction. Existing research into HIV transmission has examined the choices made by those wishing to conceive within a sexual relationship; such research shows that HIV is not a highly significant factor in their decision-making processes. This study aims to extend the debate by exploring the decision-making processes of women seeking to become pregnant with donated sperm. In particular, we focus on women outside the fertility clinic system who do not have access to sperm screened for HIV to see whether HIV is a significant factor in these women's decisions. The study involved in-depth interviews with 20 women (14 lesbians, one bisexual and five heterosexuals) recruited through informal networking and snowball sampling. HIV was a salient concern for our sample, largely because of their contacts with gay men, but nonetheless most of these women took some risks. On the one hand, the conscious deliberations necessary to conceive through self-insemination facilitated risk reduction, as did factors such as 'stranger-danger'. On the other hand, factors such as the scarcity of suitable sperm donors and the women's own feelings of gratitude and loyalty to their donors mitigated against their requesting that their donor take an HIV test. This study highlights the need to provide information for women seeking self-insemination, and to remove restrictions on access to fertility clinics, in order to reduce their risk of HIV infection and subsequent vertical transmission.

Sexual behavior, knowledge of HIV transmission and prevention, perceived risk of AIDS, and safer sex behavior were studied in a sample of 289 single, pregnant, inner-city women. African-American and European-American women were equally represented. Women had poor AIDS knowledge. Sexual behavior placed women at risk for HIV infection due to the lack of condom or spermicide use. Women did not perceive themselves at risk for the AIDS virus, although they did recognize that heterosexuals were at risk. Their lack of risk perception was partly based on their having a single sexual partner. They did not regard their partner's current or past behavior as placing them at risk. Recommendations for intervention and cultural differences were discussed.

Each year in the United States, several thousand women infected with the human immunodeficiency virus (HIV) become pregnant. The scope of the pediatric HIV epidemic will be determined by the reproductive decisions of these women. Although initial studies have not documented an effect of serostatus on reproductive choice, these studies have been limited to single-risk groups (eg, drug users) and have had small numbers of participants. We studied 108 HIV-seronegative women and 98 seropositive women through an index pregnancy and for an average of 1.5 years postpartum. Thirty-four of the seronegative women (31%) and 32 of the seropositive women (33%) learned their serostatus early enough in pregnancy to have the option to undergo abortion. One of the 34 seronegative women (2.9%) and six of the 32 seropositive women (18.8%) chose abortion (P less than .05). During follow-up, we found no significant differences in the numbers of pregnancies or live births between seropositive and seronegative women, or between drug-using and non-drug-using women. Among those who developed AIDS (N = 10), no live births occurred during followup. Although positive HIV status did correlate with the decision to terminate pregnancies, it did not correlate with subsequent fertility.

A descriptive educational needs assessment was conducted at a southwestern military medical center on knowledge, attitudes, beliefs, and self-identification of risk factors for acquired immunodeficiency syndrome (AIDS). A self-report questionnaire was administered to 700 pregnant women. Misinformation and lack of knowledge about AIDS were identified. A small group of women reported that they were at risk for AIDS. The study findings support a need for AIDS educational programs for childbearing women.