Social and behavioural determinants of HIV screening during pregnancy

Background Portugal presents the highest rate of HIV/AIDS infection in Western Europe but prevalence among pregnant women is 0,3% and mother-to-child transmission less than 2%. National guidelines recommend preconception and prenatal HIV testing. Though pregnant women are entitled to free universal care different barriers are present and women may enter labour without information on HIV status. Thus we aimed to identify factors associated with maternal knowledge and maternal passeport information regarding HIV testing. Methods We evaluated 1508 women consecutively delivered (June to September 2006) at level 3 maternity units using a comprehensive questionnaire. Logistic regression was used to quantify the association between women characteristics (social, demographic, behavioural and clinical) and self-reporting and record information on HIV testing during pregnancy. Results At least one HIV test during pregnancy was reported by 78% and 85% of the maternal passports mentioned at least one result. Among women unaware of having a test or stating not to have done it, 80% had at least one registry. After adjustment, more educated women (>12 years, OR=5.80; 95%CI 3.51-9.55) and private prenatal care (OR=1.89; 95%CI 1.35-2.64) reported more frequently to have at least one test during pregnancy and those that enter care after week 12 did it less frequently (OR=0.66; 95%CI 0.44-0.98). No factors were significantly associated with recorded information except for multiparity (OR=0.73; 95%CI 0.54-1.00, compared to primiparae). Conclusions: Social disadvantage remains an important factor for not having HIV test, a free opting-out offer, in a country with universal access to prenatal care.