Background:  In Africa 55% of HIV-1⁺ adults are women and most of them are of child-bearing age. Mother-to-child transmission of HIV can occur during pregnancy, delivery, and postpartum through breast-feeding. In developing countries mother-to-child transmission can be reduced through single-dose nevirapine to mother and child and formula feeding.

Methods:  We analyzed the prevalence of HIV-1, HIV-2, HBV, HCV, and HTLV-1 in pregnant women in Bissau. Formation programs for health care workers of antenatal clinics were organized. In the clinics health information is provided to pregnant women followed by pre-test HIV voluntary counseling and testing, HIV status is verified using Genie II HIV1/2 (BioRad) and a blood dried spot is collected for subsequent ELISA testing for HBV, HCV, and HTLV-1. Prevention of mother-to-child transmission relied on single-dose nevirapine to the mother during labor and single-dose nevirapine to the child within 72 hours from delivery. Formula feeding was implemented.

Results:  Since January 2002, 7816 pregnant women accepted testing for HIV. The global prevalence of HIV was reflected at 7.59%:  HIV-1 4.75%, HIV-2 1.66%, HIV 1/2 1.18%. Prevalence of HIV-2 was higher in older and married women. Some women refused testing because of fear of stigmatization and distance from the 4 antenatal clinics (56% acceptance). After extension of the program to 14 centers and further information programs to health personnel, acceptance of testing rose to 82%. Of pregnant women tested. 16.1% were positive for HbsAg with a prevalence of 31.8% in HIV-infected women; 7% were positive for HCV; and 5% for HTLV-1 antibodies without significant difference between healthy and HIV-infected women.

Conclusions:  According to our data, the prevalence of HIV infection in a group of pregnant women in Bissau is higher than the prevalence estimated by the Ministry of Health in 1999. Higher prevalence of HIV-2 in older women may be related to predominance of HIV-2 virus in Guinea Bissau until 1990. To address the initial low compliance and to increase the acceptance of the test we improved pre-test counseling, providing psychological help and increasing the number of antenatal clinics. With a specific program on preparation and administration of formula and monthly checks of children’s health status, we did not observe any severe diarrhea or related death. The high prevalence of HBsAg underlines the need for a specific prevention and control program.

Keywords: MTCT; HIV prevalence; VCT