Haritha Sagili completed her post graduation in Obstetrics and Gynecology from Jawaharlal Institute of Postgraduate Medical Education and Research, a referral tertiary care and teaching hospital in Puducherry, South India with an annual delivery rate of 15,000/year. She then pursued her further career in the UK for 4 years where she passed the MRCOG and MFSRH examinations. She joined back her alma mater as an Assistant Professor in 2009 as she is passionate about teaching. She has about 45 publications to her credit and is currently involved in various research projects.
Background/Purpose: Maternal to child transmission (MTCT) is responsible for over 90 % of all childhood HIV infections. Lack of awareness regarding HIV and preventive practices against MTCT maybe one of the reasons behind high HIV transmission rates. In our study, we assessed the knowledge of HIV/AIDS in antenatal women, attending a tertiary care hospital in India as well as their attitude toward voluntary counseling and testing (VCT) for HIV.
Materials and Methods: This was a cross-sectional descriptive study carried out from May–July 2012 using a pretested interview-based questionnaire given to 386 antenatalwomen after obtaining consent. Data were abstracted for knowledge of HIV,MTCT, and attitude toward VCT. Results were expressed as percentages using SPSS v.16 software.
Results: Amongst the respondents, 92.5 % had heard of HIV and in 41 % of them, the source of information was through mass media. 81 % were aware of sexual intercourse as a mode of transmission of HIV while 55 % knew that sharing sharp objects and infected blood products can spread HIV. 37.6 % of respondents were aware of MTCT and 44 % heard of antiretroviral therapy as a method of prevention of MTCT. While 68 % were willing to get tested for HIV, 18.9 % knew about the steps involved and 44 % knew where to get VCT.
Conclusion: There exists a lack of adequate knowledge regarding HIV and preventive practices against MTCT. Health education and awareness campaigns on MTCT prevention and VCT promotion should target women in their antenatal period in order to increase acceptability and
accessibility of these services.
Keywords : HIV/AIDS, Maternal to child transmission (MTCT), Voluntary counseling, Testing (VCT), Antiretroviral therapy
In India of the estimated 1.8–2.9 million people living with HIV, 39 % are women with a national antenatal prevalence of 0.48 % [1]. Mother-to-child transmission (MTCT) is responsible for 90 % of childhood HIV infections [2]. The transmission of HIV from infected mothers to infants can occur during antenatal (in utero by transplacental spread), intrapartum (during delivery through an infected birth canal), or postpartum period (through breastfeeding) [3]. Although MTCT accounts for a little less than 4 % of all HIV infections in India, it is the cause of approximately 56,700 children infected with HIV each year [4].
The lack of adequate knowledge regarding HIV and preventive practices against mother-to-child transmission may be one of the reasons for HIV transmission from mother to fetus. In the absence of an effective vaccine and cure, voluntary counseling and testing (VCT), consisting of a minimum of pre- and post-test counseling and testing, has been used as an entry point for behavior change and access to antiretroviral treatment. VCT is thus essential in the prevention of MTCT of HIV through the use of antiretroviral drugs and modification of infant feeding practices [5]. Without these interventions, mother-to-child transmission occurs in 21–32 % of HIV-positive pregnancies [5].
It is now accepted that pregnant women should be offered universal screening to enable those diagnosed with HIV to take up interventions to reduce MTCT [6]. Therefore, it is essential to assess the knowledge about HIV/ AIDS among antenatal women and their attitude toward voluntary counseling and testing for HIV.
This cross-sectional descriptive study was carried out at a tertiary care hospital in South India. The study protocol was cleared by the Institute Research and Ethics committees. All attendees at the antenatal clinic in our hospital during the period from May 2012 to July 2012 were approached personally by the investigator and informed consent was taken for inclusion into the study. Sample size or the study was estimated to be 384 with 5 % precision at 5 % level of significance, and an assumption of 50 % antenatal mothers to have knowledge about HIV. A pretested interview-based questionnaire was administered to all participants taking part in the study (Fig. 1).
Parameters studied include general knowledge of HIV, specific knowledge regarding MTCT, and attitude toward screening of HIV and voluntary counseling. Data were expressed as percentages and then analyzed.
During the study period, 400 antenatal clinic attendees were contacted and 386 subjects responded to participate in the study (96.5 %). In this study, majority of the subjects (52.8 %) belonged to the age group of 21–25 years (N = 204), followed by 25 % in the age group 26–30 years (N = 96) (Table 1). Majority of subjects were educated up to high school (45 %), while 30 % received education till higher secondary and graduation. 54 % of subjects were primigravida, while 37 % were multigravidae. Of the study subjects, 80 % were housewives, while the remaining 20 % were agricultural workers, laborers or other occupations. Almost all the subjects accessed government health facilities (98 %), while eight subjects availed healthcare from private clinics as well. Knowledge of transmission of HIV, prevention of infection and VCTamong study groups is summarised in Table 1.
While 81 % of the subjects were aware of sexual intercourse as a mode of transmission, only 37.6 % were aware of MTCT. Almost 45 % of women did not know that sharing sharp objects and blood transfusion can result in spread of infection. Regarding awareness of mother-tochild transmission of HIV, half the subjects were aware that transmission could occur during pregnancy and 44 % felt that infants would get infected through breast milk; however, 72 % did not know that transmission occurs during vaginal delivery. However, 31 % of respondents felt that a person can get HIV by sharing a meal with someone who is infected (Table 2).
While 70 % were aware that HIV is preventable, only 41 % were aware that use of condoms prevent HIV infection. Half the subjects were aware that limiting sex to one uninfected partner prevents HIV. Although 44 % were aware of antiretroviral therapy as a method of prevention of MTCT, two thirds were not aware of the role of drugs for infants or the need for avoidance of breastfeeding (70 and 62 %, respectively).
Although 68 % were willing to get tested for HIV, only 18.9 % knew about the steps involved. While 65 % were aware of laboratory tests for detecting HIV, only 44 % were aware where VCT is done. 27 % of subjects were not willing for testing their HIV status. Of the 282 subjects who were willing for HIV testing, 38 % felt VCT is important for initiating early treatment, while 35 % felt it would help in prevention of transmission to others; 21 % felt that VCT is important to prevent transmission of HIV to their children. While 62 % of mothers felt that VCT is justifiable, only 6 % felt that HIV testing is not justified.
Though 65 % approved of routine VCT for all antenatal women, 33 % were not decided in their response. Of the 250 subjects who approved of routine VCT, 248 women thought that testing should be done for antenatal women and their spouses at the same time. Preferred timing for screening for HIV among the respondents was during the antenatal period (30 %), while 27 % women felt that testing needs to be done before marriage. 24 % mothers felt that testing is warranted only at times of illness.
Amongst the study subjects, 92.5 % had heard of HIV (N = 357), while only 29 subjects (7.5 %) had not heard of HIV. In 41 % subjects, the source of information (Fig. 2) was through mass media like television or radio, while 18 % heard about HIV in schools. Other sources of information regarding HIV were through health workers, friends, newspapers, and multiple sources. Half the subjects were aware of HIV for less than 5 years, while onethird of the subjects have known about HIV for 6–10 years.
Although the spread of HIV/AIDS is a major concern in India, only 61 % of women aged 15–49 and 84 % of men aged 15–49 have heard of AIDS as per NFHS-3 data, while 92.5 % of the subjects in our study had heard of HIV. This might be due to the increasing awareness in this part of country or the population selected. In a recent study of pregnant women in South India, nearly all had heard of HIV/AIDS and one-third had general knowledge of the disease [7]. The most effective means of getting educational AIDS messages out to this population is through TV and mass media, a finding that is consistent with previous studies [8–10]. The results of this study indicate that the majority of pregnant women from this urban area of India have a good working knowledge of HIV/AIDS. Therefore, HIV knowledge rates in pregnant women continue to rise and appear to be approaching rates traditionally found in higher risk populations [11, 12].
Without interventions, between 20 and 45 % of infants may become infected from HIV-positive mothers and well over 90 % of children less than 15 years living with HIV have been infected through mother-to-child transmission [13, 14]. Regarding awareness of mother-to-child transmission of HIV, half the subjects were aware that transmission could occur during pregnancy and 44 % felt that infants would get infected through breast milk; however, 72 % did not know that transmission occurs during vaginal delivery. A study by Adeleke et al. on awareness and knowledge of MTCT of HIV among mothers attending a pediatric HIV clinic in northern Nigeria also found that more than half of the respondents had no idea on MTCT; only 6 and 24 % knew cesarean section and avoiding breastfeeding, respectively, could have roles to play in MTCT [15]. This pattern of poor comprehensive knowledge about MTCT of HIV has been identified by previous studies both within and outside Nigeria [16, 17].
Thus, there is need for community education programmes on HIV/AIDS to emphasize on how to prevent MTCT, as this will likely improve uptake of VCT and reduce stigmatization among people living with HIV and help reduce spread of HIV from MTCT.
