1. Nicholas Seeliger, MD Journal Club 24 October 2007
Determinants and Prevalence of HIV infection in pregnant Peruvian women: AIDS 2003, Vol 17 No 4
Nicholas Seeliger, MD
Journal Club
24 October 2007

2. Overview Problem Population Intervention Comparison Outcome Numbers
Statistics

3. Problem
Prevalence of HIV infection in heterosexuals in Peru is unknown
Risk factors for HIV infection in heterosexuals in Peru is unknown
Aim to identify useful risk markers to improve prevention, treatment, and reduce transmission

4. Population
Pregnant patients presenting to major hospital in Lima, Peru
12,436 consecutive pregnant women from
The Instituto Materno-Perinatal (IMP)
15% of all deliveries in Lima
Majority of patient living at low socio-economic status = complete poverty

5. Intervention
Patients completed standardized interviews concerning risk factors
Physicians completed serologic tests for HIV and syphilis

6. Comparison Cross-sectional study
Comparison of pts diagnosed with heterosexually contracted HIV infection vs. patients without HIV infection
Risk Factors Identified

7. Outcome
Likelihood of patient having / contracting HIV based on several risk factors
Likelihood of patient not having / contracting HIV based on several risk factors

8. Number of Patients 12,436 patients included
Consecutive consenting pregnant women presenting to IMP from mid-August 1996 – mid-April 1997
None refused

9. Statistics
Bivariate and multivariate analyses of associations of HIV seropositivity with potential risk markers and risk factors

10. Results HIV seropositivity confirmed in 58 women (0.5%) 22.6% married
12% reported more than 2 sex partners
HIV infection associated with:
short duration of current relationship, early onset of sexual activity, number of sexual partners
perception that partner(s) is a “womaniser”
No prenatal care, age, history of STD, history of TB, history of abortion, diagnosis of HIV in a partner

11. Discussion
Confirmed the new trend of increasing prevalence of HIV in heterosexuals
Confirmed the prominent role of MEN in driving transmission of HIV in women
Identified risk factors for HIV infection providing an opportunity for prevention

12. Discussion
Confirms the concept of infections and inequalities by formally expressing the relationship between lower SES and its unavoidable risk factors (age, access to prenatal care, ect.) and infection with fatal disease
Finally, provides some modifiable risk factors that provide an opportunity for social programs focused on prevention

13. Weaknesses
HIV seropositive pregnant women not completely representative of all HIV seropositive women / or men
Population limited to urban women with likely greater access to education and labor market
Fails to include potential strategies for prevention by only identifying risk factors and not testing any interventions

14. Relevance
Of interest to all who will continue to work in international humanitarian projects
Provides framework for all interested in studying the diseases of poverty
Of personal relevance for an upcoming humanitarian trip to Peru this New Year