All pregnant women attending the antenatal clinic of a large hospital in Vellore, India (Christian Medical College Hospital) were screened for HIV infection between October 1987 and June 1992. A total of 36,953 blood samples were thus screened and 20 infected women were identified. Among these 18 women had acquired HIV infection from their husbands, who were also detected to be HIV infected. While these 18 women were monogamous, all the husbands had multiple sex partners. Two of the 20 women in this series were commercial sex workers. Among the 20, 17 (85%) women belonged to low socio-economic status, while three were from well-to-do families, with the husbands being businessmen or teachers. As the overall prevalence (0.054%) of HIV infection among pregnant women was relatively high and equal to or higher than many States in the USA and in areas outside London in the UK, the authors recommend that strict universal precautions be instituted in all obstetric practice in India.
PIP: All pregnant women attending the antenatal clinic at the Christian Medical College Hospital, Vellore, from October 1987 until June 1992 were screened for HIV antibody while testing them for evidence of syphilis using the VDRL test. The screening was done by enzyme linked immunosorbent assay (ELISA) using Vironostika Anti-Uniform, Vironostika HIV Mixt or Wellcozyme test kits. Reactive samples were retested and those confirmed reactive were subjected to Western blot test. The women were also given counselling. The husbands were then interviewed by trained social workers or physicians and tested for HIV antibodies. During these sessions, health education regarding the mode of transmission of HIV infection, risk to the newborn, family planning to prevent further pregnancies, and the use of condoms to prevent further transmission of infection was also elucidated. The women and their husbands were regularly followed up in the HIV clinic. The annual prevalence rate of infection ranged from 0.4/1000 to 1/1000 with no trend of increase over time. Among the 20 HIV seropositive women, 18 were monogamous and had received no blood transfusions. Their husbands were also found to be HIV seropositive. Each of the 18 husbands had had sex with commercial sex workers (CSWs), mostly in Vellore town. The remaining two women were CSWs and had had multiple sexual partners. The women were between 19 and 33 years of age. The husbands of the 18 married women were between 21 and 44 years of age. Seventeen (85%) women, including the two CSWs, were of low socioeconomic status. Three women ( 15%) belonged to middle class families. None of the women had clinical features of AIDS. Seventeen (85%) women had normal vaginal delivery; two (10%) had forceps delivery while one (5%) had caesarian section. The prevalence of HIV infection in pregnant women is already relatively high in the Vellore region and therefore all institutions providing obstetric care should institute strict infection control procedures in order to avoid risk to clients and health workers.