Trends in obesity, underweight, and wasting among women attending prenatal clinics in urban Tanzania, 1995-2004

BACKGROUND: Many developing countries are currently burdened by both undernutrition and increasing rates of overweight and obesity. Scarce data are available from population studies on the recent trends and current epidemiology of obesity in African settings. OBJECTIVES: The objectives were to evaluate changes in the prevalence of obesity, underweight, and wasting in women of reproductive age from Dar es Salaam, Tanzania, during the past 10 y and to identify contemporary sociodemographic correlates of these indicators. DESIGN: We estimated the prevalence of obesity [body mass index (BMI; in kg/m2) > or = 30], underweight (BMI < 18.5), and wasting (midupper arm circumference < 22 cm) in 73 689 women aged 14-52 y who attended antenatal care clinics in the city of Dar es Salaam, Tanzania, between 1995 and 2004. RESULTS: The prevalence of obesity rose steadily and progressively from 3.6% in 1995 to 9.1% in 2004 [adjusted prevalence ratio (PR): 1.97; 95% CI: 1.66, 2.33; P for trend for year < 0.0001]. Underweight showed only a modest decline from 3.3% in 1995 to 2.6% in 2004 (adjusted PR: 0.91; 95% CI: 0.75, 1.10; P for trend for year = 0.003), whereas no change was observed in the prevalence of wasting. In the most recent years (2003 and 2004), obesity was positively associated with age, parity, and socioeconomic status and inversely with HIV infection. Underweight was inversely related to socioeconomic status and positively to HIV status. CONCLUSION: The recent, rapid, and large increase in the prevalence of obesity in women represents a new competing public health priority in urban Tanzania, where underweight and wasting have not decreased substantially.     

HIV status and sociodemographic correlates of maternal body size and wasting during pregnancy

OBJECTIVE: To examine HIV status and sociodemographic variables as correlates of body size (height, body mass index (BMI), and mid-upper-arm circumference (MUAC)) and wasting (MUAC <22 cm) in pregnant women. DESIGN: Cross-sectional study. SETTING: Four antenatal clinics in Dar es Salaam, Tanzania. SUBJECTS: Women presenting for first prenatal visit before the 23rd week of gestation, between April 1995 and July 1997 (n=13 760). RESULTS: Mean MUAC, BMI and height were 25.5 cm, 23.5 kg/m(2) and 155.1 cm, respectively. The prevalence of HIV infection was 13.1% and the overall prevalence of wasting was 4.7%. Wasting was 34% (95% CI=3%, 73%) more prevalent among HIV-infected than in uninfected mothers, after adjusting for week of gestation, height and sociodemographic indicators. The risk of wasting associated with HIV infection was highest among women with low level of education or unable to contribute to the household income. From a multiple linear regression model, BMI was positively associated with mother's age, level of education and money spent on food, but not with HIV infection, after adjusting for week of gestation. In multivariate analysis, height increased monotonically by categories of maternal age and level of education, and was also positively correlated with the ability to contribute to household income, the amount of money spent on food per person per day, and having a professional partner. CONCLUSION: HIV infection is a significant risk factor for wasting among pregnant women, particularly in groups of low socioeconomic status (SES). SES indicators are strongly correlated with maternal height and with BMI during the first and second trimesters of pregnancy independently of HIV status. SPONSORSHIP: The National Institute of Child Health and Human Development (NICHD R01 32257), and the Fogarty International Center (NIH D43 TW00004).     

云南省德宏州2005-2010年未婚孕产妇艾滋病病毒感染及其影响因素分析

目的:了解云南省德宏州未婚孕产妇艾滋病流行趋势,探讨影响未婚孕产妇感染艾滋病病毒(HIV)的危险因素。方法:收集2005-2010年间进入德宏州各级医院和计划生育服务站就诊的未婚孕产妇的社会人口学、行为学和HIV感染信息,对HIV阳性者血清进行BED-捕获酶联免疫试验(BED-CEIA)以检测其是否系新近感染者。结果:德宏州2005-2010年间共调查12 742例未婚孕产妇,HIV感染率和新近感染率分别为0.71%和0.25%。2007年HIV感染率和新近感染率最高,分别为1.13%和0.86%。多因素logistic回归分析结果显示,缅甸籍(AOR:2.57;95%CI:1.13～5.84)未婚孕产妇HIV感染率较高,而高中/中专文化程度(AOR:0.19;95%CI:0.06～0.58)、"丈夫"/男朋友无吸毒史(AOR:0.18;95%CI:0.04～0.75)未婚孕产妇HIV感染率较低。结论:德宏州未婚孕产妇HIV感染率及新近感染率较高。缅甸籍、"丈夫"/男朋友吸毒史、文化水平低是导致未婚孕产妇感染HIV的高危因素。有必要加强未婚孕产妇人群艾滋病防控工作。     

The pattern of mucocutaneous disorders in HIV – infected children attending care and treatment centres in Dar es Salaam, Tanzania

Background  

HIV/AIDS is associated with a wide range of mucocutaneous disorders some of which are useful in the clinical staging and prognosis of the syndrome. There is paucity of information regarding the prevalence and pattern of mucocutaneous disorders among HIV infected children attending paediatric Care and Treatment Centres (CTC) in Dar es Salaam. Objective To determine the prevalence and pattern of mucocutaneous disorders among HIV infected children attending public paediatric 'Care and Treatment Centres' in Dar es Salaam.     

Prevalence and public-health significance of HIV infection and anaemia among pregnant women attending antenatal clinics in south-eastern Nigeria

HIV infection and anaemia are major public-health problems in Africa and are important factors associated with an increased risk of adverse pregnancy outcomes. The objective of this study was to determine the prevalence of HIV infection and anaemia among pregnant women attending antenatal clinics in southeastern Nigeria. To achieve this, a cross-sectional survey was conducted during July 2005-June 2006 using standard techniques. Of 815 pregnant women studied, 31 (3.8%, 95% confidence interval [CI] 2.5-5.1) were HIV-positive. Maternal age and gestational age were not associated with HIV infection (p > 0.05). The prevalence of anaemia (Hb < 11.0 g/dL) was 76.9%, and 15 (1.8%, 95% CI 0.9-2.7) had severe anaemia (Hb <7.0 g/dL). A significantly higher prevalence of anaemia was observed among individuals in their second pregnancy trimester (p < 0.05) and those infected with HIV (p < 0.05). Since HIV and anaemia are preventable, antenatal care services could serve as a pivotal entry point for simultaneous delivery of interventions for the prevention and control of HIV infection and anaemia in pregnant women.     

A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife

This study aims at estimating the recent trends in HIV-1 prevalence and the factors associated with infection among pregnant women in the Gulu District of north Uganda, a rural area severely affected by civil strife. In 2000-2003, a total of 4459 antenatal clinic attendees of Lacor Hospital were anonymously tested for HIV-1 infection. The overall and age-specific prevalence did not show any significant trend over time. The age-standardized prevalence slightly declined, from 12.1% in 2000 to 11.3% in 2003. Increased age [20-24 years: adjusted odds ratio (AOR) 1.63; 95% CI 1.18-2.25; >or=25 years: AOR 2.56; 95% CI 1.91-3.44], residence in urban areas (AOR 1.76; 95% CI 1.41-2.18), being unmarried (AOR 1.60; 95% CI 1.27-2.01), increased age of partner (25-34 years: AOR 1.87; 95% CI 1.29-2.73; >or=35 years: AOR 2.68; 95% CI 1.72-4.16), modern occupation of partner (AOR 1.98; 95% CI 1.53-2.58), and short time of residence at the current address (AOR 1.36; 95% CI 1.05-1.76) were associated with infection. The HIV-1 prevalence in this rural district is high and similar to that observed in urban antenatal clinics, probably reflecting the effect of the last 18 years of civil strife.     

某地孕产妇HIV流行及母婴传播研究

目的：了解新蔡县孕产妇人群中艾滋病病毒（HIV）感染情况，为采取综合干预措施降低母婴传播的发生率提供依据。方法：对全县孕产妇利用孕检时机和在妇幼保健院婚检人群提供自愿咨询和免费HIV抗体检测；对HIV抗体阳性的孕产妇实施综合性干预。结果：2003年7月～2004年，有20 490名孕产妇接受了HIV自愿咨询检测（VCT），HIV抗体阳性12名，阳性率0．06％。12名HIV感染孕产妇中，经单采血浆传播6名（50％），受血传播5名（41．7％），经性接触传播1名（8．3％）；有2人其配偶为HIV抗体阳性。7名孕妇终止妊娠（58．3％），5名产妇接受综合性干预后分娩（41．7％）。结论：通过对孕产妇人群提供HIV自愿咨询检测服务和对该人群中的HIV感染者采取综合性干预措施，可防止和降低HIV母婴传播的发生率。     

Impaired fertility in women infected with HIV-1. Implications for sentinel serosurveillance]

BACKGROUND: Given the relationship between HIV infection and fertility, antenatal clinic-based HIV prevalence may not provide a good estimate of the community HIV prevalence. The objective of this work was to evaluate the impact of HIV infection on fertility among women attending antenatal clinics in Bobo-Dioulasso (Burkina Faso), and to discuss possible implications on HIV sentinel surveillance. METHODS: In the context of a phase II/III clinical trial of a short course of Zidovudine during pregnancy (DITRAME - ANRS 049 trial) we consecutively proposed voluntary counselling and HIV testing (VCT) to 1349 women aged at least 18 years, carrying a pregnancy of 7 months or less and living in Bobo-Dioulasso. During pre-test counselling session, a standardised questionnaire was administered to collect detailed information regarding socio-demographic characteristics and obstetrical history. Blood samples were then taken and tested for HIV after written informed consent. RESULTS: Mean age (+/- standard deviation) at first sexual intercourse was similar among HIV-infected (HIV+) (16.7+/- 2; n=83) and HIV-negative (HIV-) women (16.9+/- 2; n=1336). However, HIV+ women aged 25 years and above had, on the average fewer pregnancies (3.8+/- 1.5; n=37) than HIV- women (5.0+/- 2.3; n=567), p<0.01. Similarly, these HIV+ women had, on average, less live births (2.8+/- 1.3; n=35) than HIV- ones (3.7+/- 2.1; n=555), p=0.02. Other sexual and obstetrical characteristics such as maternal age, proportion of primigravidae, stillbirths or spontaneous abortions were comparable between HIV+ and HIV- women. CONCLUSIONS: Our data suggest that the level of fertility of HIV+ women aged 25 years and above is significantly lower than for HIV- women. Therefore, HIV+ women in this age group are likely to be under-represented among antenatal clinic attendees. These findings suggest adjusting antenatal clinic-based HIV sentinel surveillance data for age and fertility in order to derive a good estimate of the community HIV prevalence.     

Seroprevalence of the human immunodeficiency virus (HIV) among pregnant women in eastern Sudan

We conducted a cross-sectional survey to determine the prevalence of the human immunodeficiency virus (HIV) among pregnant women attending a major hospital in Kassala state, eastern Sudan. Unlinked anonymous testing of residual blood specimens, which were originally collected for other routine clinical purposes, was performed using rapid immunochromatographic assays. In total, 430 residual blood specimens were consecutively collected over a 6-week period (April-May 2010). Specimens from the antenatal clinic (ANC) constituted 50.7% (218/430) of the total whereas specimens from the labour ward accounted for the remaining 49.3% (212/430). The median age of pregnant women was 29 years (range 16-40). The prevalence of HIV-1 infection was 0.23% (1/430) [95% confidence interval=0.01-1.29%]. The only reactive specimen came from a 20-year-old ANC attendee. We report low HIV prevalence among pregnant women in eastern Sudan but further research is needed to confirm our findings. An integrated framework to diagnose and treat maternal HIV infection should be developed in order to prevent transmission to infants.     

Introduction of routine HIV testing in prenatal care--Botswana, 2004

In 2003, approximately 37% of pregnant women in Botswana (2001 population: 1.7 million; approximately 40,000 births per year) were infected with human immunodeficiency virus (HIV). Since 2001, all prenatal clinics in Botswana have offered HIV screening and interventions for prevention of mother-to-child transmission of HIV (PMTCT), which can decrease vertical transmission of HIV from 35%-40% to 5%-10%. Historically, HIV testing in Botswana has been performed after individual pretest counseling, with patients actively choosing whether to be tested (i.e., an "opt-in" approach). In 2003, 52% of pregnant women receiving prenatal care nationwide learned their HIV status. In 2004, to increase use of free national PMTCT and antiretroviral treatment (ARV) programs, Botswana began routine, noncompulsory (i.e., "opt-out") HIV screening in prenatal and other health-care settings. Concerns have been raised that routine testing in Africa might deter women from seeking prenatal care and might result in fewer women returning for their test results and HIV care after testing. To assess the early impact of routine testing on HIV-test acceptance and rates of return for care, the CDC Global AIDS Program and the PMTCT program in Botswana evaluated routine prenatal HIV testing at four clinics in Francistown, the second largest city in Botswana, where HIV prevalence has been > or =40% since 1995. This report describes the results of that assessment, which indicated that, during February-April 2004, the first 3 months of routine testing, 314 (90.5%) of 347 pregnant women were tested for HIV, compared with 381 (75.3%) of 506 women during October 2003-January 2004, the last 4 months of the opt-in testing period (p<0.001). However, many women who were tested never learned their HIV status because of logistical problems or not returning to the clinic. Substantial increases in HIV testing of pregnant women were also observed at the Francistown referral hospital and at prenatal clinics nationwide. These findings highlight the potential public health impact of routine HIV testing with rapid, same-day results for programs seeking to increase the number of persons with access to HIV-prevention and treatment services.     

Prevention of mother-to-child transmission of HIV infection: Ukraine experience to date

BACKGROUND: Despite the availability of effective interventions for the prevention of mother-to-child transmission (PMTCT), questions remain regarding implementation of programmes in settings with limited resources. This article sets out to describe the first 2 years of the implementation of the national PMTCT programme in Ukraine. METHODS: National data sources and data from a cohort of pregnant HIV-infected women delivering in 13 centres in Ukraine since 2000 were analysed. RESULTS: Interventions for prevention of MTCT have been implemented as a national programme within Ukraine's well developed infrastructure for maternal and child health. Implementation of an 'opt-out' model of counselling and HIV testing in antenatal clinics resulted in a 97% uptake of women who agreed to be HIV tested. In 2002, approximately 91% of HIV-positive pregnant women received ARV prophylaxis (mainly single-dose nevirapine or short-course zidovudine) for PMTCT. The MTCT rate has decreased from 30% in 2000 to 10% in 2002. The need to scale-up prevention interventions in pregnant women with risky behaviour and late access to medical services was identified in a review of the national programme in 2003. CONCLUSIONS: Further implementation of a comprehensive approach for the prevention of HIV infection in infants, including more extensive ART regimen, as recommended by WHO, would help Ukraine to achieve the strategic goal of virtual elimination of HIV infection in infants by 2010.     

云南省2000-2007年静脉吸毒者、性病就诊者和孕产妇HIV-1新近感染率及流行趋势变化

目的 在云南省艾滋病监测哨点用BED-CEIA方法 开展HIV-1新近感染检测,估箅新近感染率和流行趋势.方法 收集2000-2007年云南省静脉吸毒(IDU)监测哨点、性病门诊监测哨点和孕产妇监测哨点样本,采用连续的横断面调查,对经过血清学检测确认为HIV-1阳性样本再进行BED-CEIA检测.结果 研究样本共计144 780份,检出HIV-1阳性样本4932份,完成BED-CEIA检测4678份,判为新近感染样本723份.相邻两年样本合并分析,2000-2007年IDU监测哨点HIV-1平均感染率在18.2%～26.9%之间,新近感染率分别为14.65%、6.21%、4.06%、2.23%;性病门诊监测哨点HIV-1平均感染率在1.6%～3.2%之间,新近感染率分别为1.46%、0.76%、0.52%、0.33%;孕产妇监测哨点HIV-1平均感染率在0.2%～0.5%之间,新近感染率分别为0.16%、0.11%、0.10%、0.09%.结论 三类监测人群中,IDU、性病门诊就诊者和孕产妇新近感染率有所下降.     

Abortions in a hospital setting: hidden realities in Dar es Salaam, Tanzania.

This study investigates the extent of unwanted pregnancy, the use of illegally induced abortion, and the attitudes toward and practice of contraception among women admitted to a hospital with the diagnosis of abortion in Dar es Salaam, Tanzania. (In Tanzania, induced abortion is permitted only to save the mother's life.) A random sample of 300 women with early pregnancy loss admitted to Muhimbili Medical Centre, the teaching hospital in Dar es Salaam, were interviewed between September and November 1987, using a structured questionnaire. Among the 300 respondents, 155 said that their pregnancy had been unwanted: 94 of them presented with an illegally induced abortion and 61 with a spontaneous abortion. The number of spontaneous abortions of unwanted pregnancies increased with age and stability in a relationship. Having a small child to look after and having completed the family were the most common reasons for the pregnancy to be unwanted in this group. Induced abortion was more a problem of the young, unmarried woman. The 61 women with spontaneous abortion but unwanted pregnancy suggest that a much larger group of pregnant women continue to term with what are, at least initially, unwanted pregnancies--precisely the group of women family planning programs want to reach. The low prevalence of contraceptive use in this group indicates the failure of family planning clinics to motivate their target group. Recommendations are made for improved functioning of family planning clinics.     

IPT coverage and determinants of care coverage in Tanzania

BACKGROUND:TB is a major cause of mortality worldwide, with the highest risk in people living with HIV/AIDS (PLWHA). Isoniazid preventive therapy (IPT), in combination with antiretroviral therapy (ART), reduces the overall incidence and mortality from TB by up to 90% among PLWHA. Tanzania has limited published data on IPT coverage among PLWHA.OBJECTIVE:To investigate coverage and determinants of IPT among PLWHA receiving care in selected care and treatment clinics in Dar es Salaam, Tanzania.METHODS:An analytical cross-sectional design to study 31,480 HIV-positive adults. Proportions and comparisons were obtained using χ² tests, while determinants for IPT were assessed using adjusted multivariable analysis.RESULTS:The IPT coverage among eligible PLWHA was generally low (28.9%), with increased coverage over time. The determinants for IPT coverage included age >36 years, having WHO Clinical Stages 1 and 2 compared to 3 and 4, and having normal weight, or being overweight and obesity compared to underweight.CONCLUSION:IPT coverage in Dar es Salaam is very low; individuals with minor HIV disease severity were more likely to initiate IPT. This shows a possible gap in the prescribing practices among healthcare providers. More efforts to ensure IPT coverage implementation in Dar es Salaam are required.     

Prevalence of and risk factors for HIV infection in blood donors and various population subgroups in Ethiopia

The aim was to determine the prevalence of HIV infection and risk factors for HIV infection in various population subgroups in Ethiopia. Serum panels from blood donors (n = 2610), from various population subgroups in Ethiopia were tested for anti-HIV-1/2 by ELISA. All ELISA repeatedly reactive samples were subjected for confirmation by immunoblot (IB) and anti-HIV-1 and anti-HIV-2 specific ELISAs. 155/2610 (5.9%) blood donors were HIV-1 infected. Of pregnant women, 84/797 (10.5%) were HIV-1 infected, and 1/797 (0.1%) was HIV-2 infected. 1/240 (0.4%) individuals from the rural population were HIV-1 infected. 198/480 (41.3%) female attendees, and 106/419 (25.3%) male attendees at sexual transmitted disease (STD) clinics were HIV-1 infected. One (0.2%) male, and 2 (0.4%) female STD patients were infected with both HIV-1 and HIV-2. It was concluded that the prevalence of HIV-1 infection varied from 0.4% among urban residents to 25.3-41.3% among STD attendees. There is a low prevalence of HIV-2 present in Ethiopian subjects. Risky sexual behaviour is significantly associated with HIV-infection in Ethiopia.     

Prevention of mother-to-child transmission of HIV in a refugee camp setting in Tanzania

Abstract

The objective of this article is to describe the results of a 2-year pilot programme implementing prevention of mother to child HIV transmission (PMTCT) in a refugee camp setting. Interventions used were: community sensitization, trainings of healthcare workers, voluntary counselling and HIV testing (VCT), infant feeding, counselling, and administration of Nevirapine. Main outcome measures include: HIV testing acceptance rates, percentage of women receiving post test counselling, Nevirapine uptake, and HIV prevalence among pregnant women and their infants. Ninety-two percent of women (n=9,346) attending antenatal clinics accepted VCT. All women who were tested for HIV received their results and posttest counselling. The HIV prevalence rate among the population was 3.2%. The overall Nevirapine uptake in the camp was 97%. Over a third of women were repatriated before receiving Nevirapine. Only 14% of male counterparts accepted VCT. Due to repatriation, parent's refusal, and deaths, HIV results were available for only 15% of infants born to HIV-infected mothers. The PMTCT programme was successfully integrated into existing antenatal care services and was acceptable to the majority of pregnant women. The major challenges encountered during the implementation of this programme were repatriation of refugees before administration of Nevirapine, which made it difficult to measure the impact of the PMTCT programme.     

Anaemia during pregnancy in Burkina Faso, west Africa, 1995-96: prevalence and associated factors. DITRAME Study Group

We report the results of a cross-sectional study carried out in 1995-96 on anaemia in pregnant women who were attending two antenatal clinics in Bobo-Dioulasso, Burkina Faso, as part of a research programme including a clinical trial of zidovudine (ZDV) in pregnancy (ANRS 049 Clinical Trial). For women infected with human immunodeficiency virus (HIV) in Africa, anaemia is of particular concern when considering the use of ZDV to decrease mother-to-child transmission of HIV. The objectives were to determine the prevalence of and risk factors for maternal anaemia in the study population, and the effect of HIV infection on the severity of maternal anaemia. HIV counselling and testing were offered to all women, and haemograms were determined for those women who consented to serological testing. Haemoglobin (Hb) levels were available for 2308 of the 2667 women who accepted HIV testing. The prevalence of HIV infection was 9.7% (95% confidence interval (CI): 8.6-10.8%). The overall prevalence of anaemia during pregnancy (Hb level < 11 g/dl) was 66% (95% CI: 64-68%). The prevalence of mild (10 g/dl < or = Hb < 11 g/dl), moderate (7 g/dl < or = Hb < 10 g/dl) and severe (Hb < 7 g/dl) anaemia was 30.8%, 33.5% and 1.7%, respectively. The prevalence of anaemia was 78.4% in HIV-infected women versus 64.7% in HIV-seronegative women (P < 0.001). Although the relative risk of HIV-seropositivity increased with the severity of anaemia, no significant association was found between degree of anaemia and HIV serostatus among the study women with anaemia. Logistic regression analysis showed that anaemia was significantly and independently related to HIV infection, advanced gestational age, and low socioeconomic status. This study confirms the high prevalence of anaemia during pregnancy in Burkina Faso. Antenatal care in this population must include iron supplementation. Although HIV-infected women had a higher prevalence of anaemia, severe anaemia was infrequent, possibly because few women were in the advanced stage of HIV disease. A short course regimen of ZDV should be well tolerated in this population.     

中国1995～1998年艾滋病哨点监测报告

目的 更科学地监测我国艾滋病病毒（ＨＩＶ）感染流行趋势、为制定艾滋病防治规划和进行干预活动提供准确的信息。方法 从１９９５年起以重复横断面调查的方法对性传播疾病（ＳＴＤ）门诊就诊者、暗娼、吸毒者、长途卡车司机,以及孕产妇和供血员进行监测。结果 １９９５年首次监测的８个吸毒者监测哨点未发现ＨＩＶ感染者,２１９个吸毒者监测哨点已有１７个哨点发现了ＨＩＶ感染者。在１９９５－１９９８年乌鲁木齐点ＨＩＶ感染     

Survey on prevalence and risk factors on HIV-1 among pregnant women in North-Rift, Kenya: a hospital based cross-sectional study conducted between 2005 and 2006

Background  

The HIV/AIDS epidemic in Kenya is a major public-health problem. Estimating the prevalence of HIV in pregnant women provides essential information for an effective implementation of HIV/AIDS control measures and monitoring of HIV spread within a country. The objective of this study was to determine the prevalence of HIV infection, risk factors for HIV/AIDS and immunologic (lymphocyte profile) characteristics among pregnant women attending antenatal clinics in three district hospitals in North-Rift, Kenya.     

HIV testing and prevention issues for women attending termination assessment clinics

The prevalence of HIV infection in London is nearly threefold in women who seek terminations compared to women who carry to term. Despite the higher prevalence, HIV testing is not systematically offered to women attending termination of pregnancy assessment clinics (TOPCs). The Department of Health has given clear guidance on HIV testing in antenatal clinics and most London antenatal clinics have implemented policies on HIV testing. No similar guidance exists for TOP clinics. This paper describes the results from a study examining HIV testing and prevention issues for women attending five TOPCs in North London. Data on risk disclosure, HIV testing intentions and awareness of HIV infection and testing were analysed for 141 women who completed a self-administered questionnaire. Women who expressed an intention to have an HIV test were more likely to be from ethnic minority origin, to report that their partner intends to have an HIV test and to perceive it as easier to talk to their partner about HIV testing, compared to women who did not report an intention to test for HIV The former group also were more likely to have had a previous HIV test and perceived their personal control for staying HIV negative as greater compared to others. Fifty six (39.8 per cent) women disclosed one or more potential risk factors for HIV Women with risks were more knowledgeable about HIV infection, perceived their personal chances of being HIV positive as greater and experienced greater worry about past risks, compared to women who disclosed no risks. However, women who disclosed risk factors were no more likely to intend to have an HIV test. Knowledge on HIV infection, testing and potential interventions to reduce mother-to-baby transmission was low, with fewer than one in four women being aware that transmission may be reduced by AZT, Caesarean section and bottle feeding. Given the findings about the level of risk disclosed and women's positive attitude towards information on HIV infection and testing, this client group should no longer be overlooked in the planning of future policies on HIV testing for populations at risk.