Background:  The prevalence of HIV during pregnancy in Mexico is estimated at 0.09%. However, HIV testing is not routine during prenatal care and HIV prevalence during pregnancy at Tijuana General Hospital is unknown. In this study the feasibility and acceptance of HIV counseling and rapid testing at delivery were evaluated at Tijuana General Hospital.

Methods:  Pregnant women with unknown HIV status admitted in labor who consented to participate in the study had blood drawn for a rapid HIV test (Determine HIV-1). Women with a positive test received intravenous zidovudine and their newborns received oral zidovudine for 6 weeks. A confirmatory EIA and Western blot was performed and demographic data were extracted from each participant to assess risk factors associated with HIV infection.

Results:  From June to September 2003, 981 women in labor were offered counseling and testing and 947 (96.5%) consented to participate. The mean age was 23.6 years, 16.3% were single, 16.8% married, and 65.6% had one steady partner. HIV risk factors present were:  4.6% received blood transfusions, 2.1% used intravenous drugs, and 9.3% used “other” drugs. Parity ranged from 0 to 9 (mean 1.3 births); 22% had no prenatal care, 52% had 2 prenatal visits or fewer. Mean gestational age at delivery was 38.6 weeks (range 28 to 42 weeks). Prolonged rupture of membranes >4 hours occurred in 9.2%. Delivery was vaginal (78.4%) or cesarean (21.6%). Twelve women tested positive by Determine HIV-1; all were confirmed giving a prevalence of 1.26%. Compared to uninfected women, HIV-infected women were significantly more likely to use IV drugs (17% vs 2%, p = 0.03), “other” drugs (83% vs 9%, p <0.001), to have more sex partners (3.8 vs 2.8, p <0.001), not to have received prenatal care (53% vs 23%, p = 0.01) and to have a spouse/partner who used IV drugs (25% vs 5%, p = 0.01) or “other” drugs (42% vs 14%, p = 0.02). In multivariable regression analysis, use of “other drugs” was independently associated with the risk of HIV infection, even after adjusting for IV drug use, and number of sex partners.

Conclusions:  HIV counseling and rapid testing during labor had a high acceptance rate with a HIV prevalence of 1.26% at delivery at Tijuana General Hospital. These findings indicate that HIV infection among certain groups in Mexico is higher than is currently believed, and that counseling and testing programs are urgently needed.

Keywords: Rapid HIV test; Pregnancy; Mexico