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PubMed1984

Determination of glucosuria, an obsolete form of self-monitoring in diabetes?

During the last few years we have got improved and cheaper test materials for blood glucose determination. Self-monitoring of blood glucose has become common and urine tests have appeared more obsolete and useless than ever. Before we abandon urine tests we wanted to compare blood and urine glucose and also evaluate the opinion of our patients. A comparison of 301 parallel blood and urine glucose determinations showed a good correlation. In only 5.0% of the samples was the blood glucose above 10 mmol/l without glucosuria and in 9.7% of the samples the blood glucose was below 10 mmol/l but still with glucose in the parallel urine test. Anonymous questionnaires were answered by 94 juvenile diabetics aged between 7-25 yr. Carelessness or "cheating" had sometimes occurred in 10-20% of them. An overwhelming majority preferred daily urine test and a sporadic blood test to regular blood glucose monitoring. Urine tests seem to have a place together with blood glucose determinations in the management of juvenile diabetes.

Adolescent↗
PubMed2003

Availability of combination therapy for HIV: effects on sexual risk taking in a sample of high-risk gay and bisexual men.

The objective of this study was to assess the impact of successes in the medical treatment of HIV disease on the perceptions of high-risk gay and bisexual men attending an anonymous testing site towards becoming infected with HIV and on their decisions to have unsafe sex. A cross-sectional survey with a face-to-face interview and self-recorded information was used. A convenience sample of high-risk men seeking anonymous HIV antibody counselling was recruited for an intervention study. To be eligible, men had to have a history of at least one previous negative antibody test and unprotected anal intercourse within the last year. Upon enrollment, subjects were asked about the impact of new treatment developments on their decisions to engage in high-risk sex both in the recent past and in the future. In general, neither the recent successes in treating HIV nor the availability of combination therapy had any impact on the men's decisions about safe sex, although a minority of men reported less concern about becoming HIV-positive. Also, some men reported already having taken more risk. In conclusion, a small number of men in this high-risk population have increased risk behaviour as a result of recent treatment advances. These results merit continued monitoring.

Adult↗
PubMed2001

Detection of enterovirus viraemia in blood donors.

BACKGROUND AND OBJECTIVES: The infrastructure established for screening blood donations for hepatitis C virus has enabled large-scale population testing for other viruses which are potentially transmissible by transfusion of blood components and plasma-derived blood products. We have measured the frequency of viraemia of enteroviruses and parechoviruses in 83 600 Scottish blood donors to allow an initial assessment of their risk to blood safety. MATERIALS AND METHODS: Plasma samples collected from blood donors over 7 calendar months were tested anonymously in mini-pools of 95 donations, by polymerase chain reaction (PCR) for human enterovirus and parechovirus sequences. RESULTS: A total of 19 mini-pools, from the 880 that were tested, were PCR-positive for enterovirus RNA, predicting a donor prevalence of 0.023%. Enterovirus sequences were not detected in factor VIII or IX clotting factor concentrates. None of the 230 mini-pools or concentrates contained detectable parechovirus RNA. CONCLUSIONS: The prevalence of enterovirus viraemia detected in this study predicts that at least 1000 enterovirus-contaminated blood components are transfused per year in the UK. The frequency of transmission and clinical outcome after exposure to enterovirus-contaminated blood components in recipients is unknown.

Base Sequence↗
PubMed1994

Saliva-based HIV-antibody testing in Thailand.

OBJECTIVE: To determine whether saliva could serve as an alternative to serum for HIV-antibody testing in an ongoing sentinel surveillance program in Thailand. METHODS: Serum and saliva specimens were collected from 1955 individuals in four of the 73 sentinel sites of the national surveillance program in Thailand. Intravenous drug users, female prostitutes, and men attending sexually transmitted disease clinics were included as participants. All specimens were collected and tested anonymously. Saliva was gathered with the Omni-Sal collection device and analyzed for the presence of HIV antibodies using the immunoglobulin G antibody-capture enzyme-linked immunosorbent assay (GACELISA) laboratory test, specially designed for low concentration body fluids. Our gold standard was serum, collected and analyzed independently from the saliva specimens, using an ELISA test for screening and Western blot for confirmation. Linkage between serum and saliva was blind to the laboratory. A set of HIV-positive and HIV-negative quality assurance samples for both serum and saliva were also analyzed blind. RESULTS: Findings are presented as observed in the field, and as quality assurance samples after the correction of various field and laboratory errors. The sensitivity of the GACELISA with saliva was 98.0% in the field (298 HIV-positive specimens), 100% after correction of errors (300 HIV-positive specimens), and 100% among the quality assurance samples (95 HIV-positive specimens). The specificity of the GACELISA was 99.4% in the field (1653 HIV-negative specimens), 99.6% after correction of errors (1654 HIV-negative specimens), and 100% among the quality assurance samples (96 HIV-negative specimens). CONCLUSION: Our findings support other published studies that also featured the GACELISA. We conclude that saliva is comparable to serum for assessing HIV antibodies in individuals for surveillance and screening purposes.

AIDS Serodiagnosis↗
PubMedDate not supplied

[The organization of the work to determine antibodies to the human immunodeficiency virus in the Republic of Byelarus].

The study revealed that the method of mass screening for the detection of antibodies to HIV antigen, carried out in the Republic till 1993, proved to be economically and diagnostically unjustified. Starting from 1993, the work on the step-by-step reduction of groups to be tested for the presence of antibodies to HIV began. At the same time from 1997 the proportion of tested donors of blood, organs and tissues, as well as persons belonging to high risk groups, increased in comparison with 1993 (from 23.3% to 40% and from 5.3% to 21% respectively). Voluntary and anonymous testing for the presence of HIV infection was organized and legally introduced. In comparison with 1991, in 1997 the number of persons who voluntarily underwent testing increased 3.7 times. The period of transition from mass screening to selective one was noted to have no effect on the detection of HIV-infected persons. Since 1995 the method of "patrol" epidemiological surveillance was also used. 2,118 persons underwent testing, the results of screening were negative. During the period of 3 years the testing of 12,547 young people called up for military service revealed 28 seropositive persons in the region where an outbreak of HIV infection had been registered among addicts using drugs intravenously.

AIDS Serodiagnosis↗
PubMed1998

Limitations of current surveillance programs for sexually transmitted infections and allied conditions affecting reproductive health care.

The present communication concerns the potential of current surveillance programs for understanding the epidemiology of sexually transmitted infections. The often limited knowledge or the negligence of such infections both among health providers and in the general population, and the non-existence of laboratory services or poor utilization thereof, for example the lack of sampling material, lack of transport services for samples, lack of laboratory reagents and the use of unsensitive and unspecific detection methods, challenge the value of almost any surveillance system of these infections. Other factors are poor health-seeking behavior in the population, including hard-core groups for sexually transmitted infections, poor health economy, limited possibilities for attendees themselves to pay for etiological tests and lack of educated health providers for this type of infectious disease. Still other factors adding to the difficulty of interpreting sexually transmitted infection epidemics on the basis of monitored data are, for example, anonymous testing, double or multiple registration of detected sexually transmitted infection cases, and the chronicity of many sexually transmitted infections with relapses, which makes it difficult to differentiate between incidence and prevalence. Furthermore, partner notification legislations and bureaucracy in reporting cases can influence surveillance programs for sexually transmitted infections.

Confounding Factors, Epidemiologic↗
PubMed2004

HIV infection and risk behaviour of commercial sex workers and intravenous drug users in Slovakia.

INTRODUCTION: Aim of the study was to determine risk behaviour and HIV prevalence among commercial sex workers (CSWs) and intravenous drug users (IDUs) in streets of Bratislava and B. Bystrica, SR. METHODS: HIV antibodies were tested from saliva using ELISA test. Anonymous questionnaire was completed. RESULTS: 121 persons (61 men and 60 women) were involved in the sociological study. Mean age of the participants was 21.9 years. 185.1% of subjects were from Bratislava. 108 participants were tested for the presence of HIV-antibodies, one was confirmed HIV-positive (0.82%). In the past 47.9% of participants and 22.3% of their partners were tested for the presence of HIV-antibodies. 10.8% of subjects proclaimed that they suffered from other sexually transmitted infection (STI) in the past HIV testing of participants significantly correlated with the testing for other STI (p<0.002) as well as with HBV/HCV (p<0.001). 58 participants were using tattooing (47.9%). 46.3% of all participants never used condoms with partners. 31.4% of respondents proclaimed disruption of condom during sexual intercourse. Significant correlation was found between testing of participants for other STI and usage of condoms with their partners (p<0.013). Women used condoms more often by sexual contacts with partners than men used condoms (p<0.094). They were also significantly more tested for other STI in the past (p<0.021) and they suffered from other STI more often than men (p<0.033). 26.5% of person--only women--were involved in commercial sex work. 93.5% of them were taking drugs as well, 21.8% suffered for other STI in the past They were working in sex business on average for 26 months. The average number of their clients per week was 12.3. CSWs used condoms more often with clients than with partners. 98.2% of all participants were taking drugs, 93% of them intravenously. 24.6% of IDUs always used new or their own needles and syringes, while 69.4% shared equipments with the other users. IDUs drug users used condoms significantly less often with their partners than did CSWs (p<0.006). CSWs were significantly more often tested for other STI (p<0.001) and they also more often suffered for other STI than IDUs (p<0.045). CONCLUSION: More effort should be done to decrease risk behaviour revealed in the groups of CSWs and drug users.

Adolescent↗
PubMed1997

The Unlinked Anonymous HIV Prevalence Monitoring Programme in N. Ireland 1992-1995.

Previous evidence has suggested that Northern Ireland is a low seroprevalence area for HIV infection. The Unlinked Anonymous HIV Prevalence Monitoring Programme initiated in England and Wales in 1990 was extended to Northern Ireland in 1992. Patients attending the Genitourinary Medicine Clinic at the Royal Victoria Hospital have, with informed consent, been tested anonymously for HIV infection since that time. The results of the survey between 1992 and 1995 have shown an overall seroprevalence rate 3.01% for homosexual/bisexual men, 0.08% for heterosexual men, and 0.05% for heterosexual women. These results confirm the previous impression of low HIV seroprevalence in Northern Ireland and the survey provides an excellent longitudinal study by which changes may be monitored.

AIDS Serodiagnosis↗
PubMed1993

Unlinked anonymous monitoring of HIV prevalence in England and Wales: 1990-92.

Unlinked anonymous surveys are being conducted on accessible sentinel populations in order to monitor the prevalence of HIV infection in England and Wales. These populations have been selected either because of, or regardless of, their risks for HIV infection. Results are presented for specimens collected between January 1990 and July 1992 from 41,461 genito-urinary medicine clinic attenders, 5394 injecting drug users, 296,396 antenatal clinic attenders, 49,009 neonatal dried blood spots, and 32,796 hospital patients aged 16 to 49 years. The prevalences of HIV infection in persons attending two genito-urinary medicine clinics in London, and who were not known to have injected drugs, were 21% for homo/bisexual men, 1% for heterosexual men, and 0.6% for heterosexual women. At four clinics outside London, the corresponding prevalences were 5%, 0.3% and 0.2%, respectively. Of the homo/bisexual men who were found to be HIV infected by unlinked anonymous testing, 26% (229 out of 872) had presented with an acute sexually transmitted disease. Six per cent of male and 6.5% of female injecting drug users attending centres in London in 1991 and 1992 were infected with HIV compared with 0.8% of male and 0.4% of female injecting drug users elsewhere. The HIV infection rate was five times higher in injecting drug users who had had a previous HIV test (2.7%) than in those never previously tested (0.5%). In antenatal clinic attenders in London, HIV prevalence was twenty times higher than in pregnant women elsewhere (0.21% vs 0.01%) but there was considerable variation in prevalence between individual centres. A comparison between unlinked anonymous data and OPCS data for the 15 London centres suggested that the fraction of HIV prevalence in pregnant women at each centre attributable to the proportion of births to mothers born in Africa was between 20% and 100%. However, much of the variation in prevalence was unexplained, so that firm conclusions cannot be made about this relationship. The survey of neonatal dried blood spots showed HIV prevalence in South-East London to be 40 times the rate outside London. The prevalence of HIV infection at two London district hospitals in patients aged 16 to 49 years, from specialties which usually deal with illness not known to be associated with HIV infection, was 0.6% for men and 0.2% for women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Perinatally acquired human immunodeficiency virus infection: extent of clinical recognition in a population-based cohort. Massachusetts Pediatric HIV Surveillance Working Group.

To evaluate factors that may affect the timely diagnosis of children with human immunodeficiency virus (HIV) infection, we compared data derived from two population-based pediatric HIV studies. Data from anonymous newborn HIV serosurveys were used to estimate the number of children born to HIV-seropositive mothers. A statewide active surveillance project determined the number of HIV-exposed children who had been clinically recognized. Of 88,732 Massachusetts newborn specimens tested anonymously for HIV antibodies during a 12-month period (November, 1987, to October, 1988), 223 were positive. As of October, 1991, 78 of these children (35%) had been identified by a statewide network of infectious disease physicians. HIV-exposed children born in inner city hospitals were more likely to have come to medical attention than those born in suburban hospitals (47% vs. 17%). Among the 29 children with confirmed HIV infection (13% of 223), the initial evaluation for HIV occurred at an earlier age among children born in inner city hospitals than among children born in other areas. HIV testing practices that rely heavily on risk assessment may result in delayed diagnosis of HIV infection in children whose mothers are not perceived to be at risk.

AIDS Serodiagnosis↗
PubMed2004

Epidemiology of HIV in South Africa--results of a national, community-based survey.

OBJECTIVE: To determine HIV prevalence in the South African population and to investigate risk factors for HIV. METHODS: A national sample of 10 197 households was selected. One child (aged 2 - 14 years), one youth (15 - 24 years) and one adult (25 years and older) were randomly selected from each household. Consenting respondents were interviewed about their socio-demographic characteristics and asked to give an oral mucosal transudate sample to test anonymously for HIV. Differential response rates were compared using unweighted data. The Orasure HIV-1 device in combination with the Vironostika HIV UNI-Form II plus O enzyme-linked immunosorbent assay kits were used to collect oral fluid specimens for HIV testing. HIV prevalence within subgroups was compared using Rao and Scott's adjusted chi-square. Relative risk was calculated using Poisson regression. All analysis was on the weighted data. RESULTS: Of the 10 197 households selected, 7 249 (71.1%) were included in the study. Of the 13 518 individuals selected, 9 963 (73.7%) were interviewed. Of these, 8 428 (62.3%) agreed to HIV testing and had valid results. HIV prevalence in the general population was 11.4% (12.8% in females and 9.5% in males). Blacks had the highest prevalence (12.9%), compared with whites (6.2%), coloureds (6.1%) and Indians (1.6%). Informal settlements in urban areas had the highest HIV prevalence (21.6%). The findings of this study are consistent with South African Department of Health estimates based on the 2002 antenatal survey. CONCLUSION: The Nelson Mandela/Human Sciences Research Council survey included all race, sex and age groups. It is therefore the most reliable and valid source of information on the extent and distribution of the HIV epidemic in South Africa.

Adolescent↗
PubMed2000

Surveillance for incident HIV infection: new technology and new opportunities.

Although surveillance for HIV infection has traditionally focused on the incidence of AIDS and the prevalence of HIV, new diagnostic technologies that allow the estimation of incident HIV infection have become available. Number and distribution of new cases of HIV infection, rather than old cases, are the data most relevant to guide rational application of HIV prevention programs. Historically, incident HIV infection has been measured in longitudinal cohort studies, diagnosed clinically or since 1993 by detection of seroconverting patients (during the window period before appearance of HIV antibody) who are viremic as measured by p24 antigen or RNA-PCR. The sensitive-less sensitive EIA test (or serologic testing algorithm for recent HIV seroconversion [STAHRS]) has now made the serologic diagnosis of incident HIV infection in individual patients as well as the estimation of HIV incidence in populations possible. Examples of the public health application of this are studies of HIV incidence in anonymous test site attendees, sexually transmitted disease clinic patients, and in-treatment injection drug users in San Francisco. These sorts of studies allow us not only to measure incidence cross-sectionally but also facilitate surveillance for HIV subtypes and primary antiretroviral resistance, targeting early antiretroviral therapy and partner notification, and understanding who is "failing" prevention. Having an HIV surveillance system that focuses on incident rather than prevalent infection should be our long-term goal.

Acquired Immunodeficiency Syndrome↗
PubMed1992

HIV infection among patients in U.S. acute care hospitals. Strategies for the counseling and testing of the hospital patients. The Hospital HIV Surveillance Group.

BACKGROUND: Routine, voluntary testing of hospital patients for the human immunodeficiency virus (HIV) has been proposed in order to identify those with early HIV infection in a setting where there is ready access to counseling, appropriate clinical referral, evaluation, and therapy. We studied the pattern of HIV infection among patients in 20 U.S. hospitals, in order to evaluate possible national strategies for the routine, voluntary HIV counseling and testing of hospital patients. METHODS: Blood specimens remaining after clinical use from a systematically selected sample of patients at 20 hospitals in 15 U.S. cities were tested anonymously for antibody to HIV type 1 (HIV-1). Multivariate regression was used to determine which variables best predicted HIV seroprevalence in individual hospitals. Using these data, we estimated the number of HIV-positive patients in all U.S. hospitals and considered the efficiency of routine counseling and testing in different subgroups of patients and hospitals. RESULTS: From September 1989 through October 1991, 9286 of 195,829 specimens (4.7 percent) were positive for HIV-1 in the 20 hospitals. The seroprevalence of HIV at these institutions ranged from 0.2 percent to 14.2 percent. Among HIV-positive patients, 32 percent had symptomatic HIV infection or the acquired immunodeficiency syndrome (AIDS) at the time of admission or evaluation. In the 20 hospitals, HIV seroprevalence was 10.4 times (95 percent confidence interval, 8.8 to 12.0) the AIDS-diagnosis rate (the annual number of patients with new diagnoses of AIDS per 1000 discharges in 1990). In a multivariate model that included 13 hospital-specific variables, only the AIDS-diagnosis rate was associated with the hospital-specific HIV-seroprevalence rate (P less than 0.001). Using these data and the AIDS-diagnosis rates for all U.S. acute care hospitals, we estimated that 225,000 HIV-positive persons were hospitalized (95 percent confidence interval, 190,000 to 260,000) in all 5558 such hospitals in 1990, including 163,000 persons presenting with conditions other than HIV or AIDS (95 percent confidence interval, 130,000 to 196,000). In 1990, in 593 U.S. hospitals with AIDS-diagnosis rates of 1.0 or more per 1000 discharges, HIV testing of patients 15 to 54 years old (3 million patients, or 12.0 percent of all patients in U.S. acute care hospitals) would have identified an estimated 68 percent of all HIV-positive patients (110,000 patients) who were admitted with conditions other than symptomatic HIV infection or AIDS. CONCLUSIONS: We estimate that about 225,000 HIV-positive persons were hospitalized in 1990, of whom only one third were admitted for symptomatic HIV infection or AIDS. Routine, voluntary HIV testing of patients 15 to 54 years old in hospitals with 1 or more patients with newly diagnosed AIDS per 1000 discharges per year could potentially have identified as many as 110,000 patients with HIV infection that was previously unrecognized.

AIDS Serodiagnosis↗
PubMed1993

Sentinel surveillance for HIV-1 among pregnant women in a developing country: 3 years' experience and comparison with a population serosurvey.

OBJECTIVES: To establish unlinked, anonymous sentinel surveillance for HIV-1 among pregnant women attending an antenatal clinic, to determine age-specific seroprevalences, to monitor trends and to compare seroprevalence with that detected by a population serosurvey. To establish the sustainability and costs of surveillance. DESIGN: Sentinel surveillance for HIV through serial collection of unlinked, anonymous seroprevalence data from antenatal care; comparison of sentinel data with those from a population serosurvey; financial and general audit of the sentinel surveillance. SETTING: A community antenatal clinic in a large urban centre, Mwanza Municipality, Tanzania, eastern Africa, between October 1988 and September 1991. PATIENTS: Pregnant women attending for antenatal care. MAIN OUTCOME MEASURE: Age-specific HIV-1 seroprevalences, trends over time, difference from age-specific population seroprevalences, sustainability and costs. RESULTS: Overall HIV-1 seroprevalence was 11.5% (95% confidence interval, 10.5-12.4); differences in age-specific prevalences were not significant. There was no clear evidence of change in seroprevalence over the study period in any age group, although there was some indication of a rise in some age groups in 1988-1989. Sentinel surveillance among pregnant women may have significantly underestimated population HIV-1 seroprevalence for women under the age of 35 years. HIV-1 surveillance proved feasible and sustainable. Additional recurrent costs were US$1.7 per specimen for unlinked anonymous testing and US$0.57 per woman for syphilis screening. CONCLUSIONS: HIV-1 seroprevalence did not change significantly over 3 years, probably implying a substantial incidence of HIV-1 infection. In this setting seroprevalence in pregnant women may have underestimated population seroprevalence in women aged under 35 years. With modest inputs and good organization unlinked anonymous HIV-1 sentinel surveillance of pregnant women can be introduced and sustained in an African setting. This may usefully be carried out in conjunction with syphilis screening.

AIDS Serodiagnosis↗
PubMed1999

[The survey of HIV infection among clients of foreign female prostitutes in Tokyo Metropolitan].

OBJECTIVES: It is important to elucidate the risks to foreign female prostitutes of HIV infection from their clients. We determined the prevalence of HIV among clients of foreign female prostitutes using anonymous testing of condom semen samples. METHODS: A total of 250 client condom semen samples were collected with client age and nationality by 15 Latin American and 37 Thai female prostitutes in Tokyo from March to May 1995. We screened by ELISA (GENELAVIA MIXT, Pasteur Sanofi Diagnostics) for antibody to HIV 1 and 2, and then confirmed by Western Blot (LAV Blot 1, LAV Blot 2, Sanofi Diagnostics Pasteur) and distinguished by Immuno Blot PEPTI-LAV 1, 2, (Sanofi Diagnostics Pasteur). RESULTS: The nationality of customers was reported as Japanese (74.8%), Iranian (7.6%), Pakistan (5.6%), Indian (2.8%), Taiwanese (2.0%), and Chinese (1.2%) with other nationalities less than 1.0%. Estimated age categories of the clients were < 20 (1.2%), 20-29 (41.2%), 30-39 (36.4%), 40-49 (12.4%), > or = 50 (6.4%) and undetermined (2.4%). Of the 250 samples collected, only 219 were sufficient for testing. Two samples (0.90%, 95% CI = 0.4-2.2%) were HIV 1 positive, both from Japanese clients (1.2% of Japanese clients, 95% CI = 0.5-2.9%). These data suggested that the prevalence of HIV in clients of female prostitutes was relatively high, and can be considered a risk group in Japan. The sentinel surveillance by anonymous of client condom semen samples is a very useful method to quantify HIV prevalence in this risk group.

Acquired Immunodeficiency Syndrome↗
PubMed2000

A participant observation study using actors at 30 publicly funded HIV counseling and testing sites in Pennsylvania.

OBJECTIVES: This study was designed to augment an evaluation of Pennsylvania publicly funded HIV counseling and testing sites, particularly of the staff-client interaction. METHODS: Actors were trained as research assistants and sent to 30 randomly chosen sites to be tested and counseled for HIV disease. Instruments based on Centers for Disease Control and Prevention (CDC) guidelines were designed and used to evaluate them. RESULTS: Data were generated that identified the range of compliance with CDC guidelines and state policy. Among the findings were that 10 of 30 sites required signed consents despite a state policy allowing anonymous testing. Only 17% of providers developed a written risk reduction plan, even though 69% of all sites surveyed by mail asserted that such plans were developed. Only 2 of 5 HIV-positive actors were offered partner notification services, even though 100% of sites visited by an interviewer claimed to offer such services. CONCLUSIONS: The findings suggest that although evaluation methods such as mail surveys and site visits are useful for evaluating the existence of appropriate policies and protocols and gathering baseline data, they might not be sufficient for assessing actual staff-client interaction.

AIDS Serodiagnosis↗
PubMed1997

Deliveries, abortion and HIV-1 infection in Rome, 1989-1994. The Lazio AIDS Collaborative Group.

The prevalence of HIV-1 among women of reproductive age is currently estimated at the time they give birth. We assessed HIV-1 prevalence at the end of pregnancy, whether they delivered or had an induced or spontaneous abortion. Women admitted at the end of pregnancy to hospitals in the Lazio Region, Italy, were tested for antibodies to HIV-1. Consent for testing was granted by 97.1% of 218,357 subjects; women who did not consent were tested anonymously. The prevalences of infection were 0.34% in 1989, 0.38% in 1990, 0.28% in 1991, 0.23% in 1992, 0.28% in 1993, and 0.24% in 1994. Significantly higher prevalences of infection were associated with induced abortion (0.49%) than with delivery (0.18%; OR: 2.72; 95% CI: 2.29-3.22) and among women who refused (0.85%) than among those who consented to testing (0.27%; OR: 3.14; 95% CI: 2.35-4.19). A significant temporal reduction in prevalence was observed only among women who delivered (0.15% in 1993 and 1994; 0.26% in 1989 and 1990). The prevalence of HIV-1 infection is thus higher among women undergoing induced abortions than among those who deliver and higher among women who refuse testing than among those who consent. Studies confined to neonatal testing or to voluntary testing of pregnant women would thus underestimate the prevalence of HIV-1 among women of reproductive age.

AIDS Serodiagnosis↗