Objectives: To describe clinical and socio-economic conditions associated with HIV and syphilis infections among urban, pregnant Malawian women.

Materials And Methods: Between Dec. 2000 and March 2004, cross-sectional clinical and socioeconomic data were collected from consenting women attending the Antenatal Clinic (ANC) at Queen Elizabeth Central Hospital Blantyre, Malawi. HIV-1 status was determined concurrently with the Determine and SeroCard rapid tests; syphilis was defined as RPR/TPHA double positive women. The association between nominal categories and infection was evaluated with the Pearson’s chi² test for independence of the cells; trends in ordinal variables were tested with a chi² statistic. Prevalence odds ratios (ORs) were calculated from contingency tables and tested with a chi-squared statistic.

Results: Of the 6184 women invited to participate in this study, 3,824 (62%) were enrolled, of whom 1156 were HIV seropositive (30.2%).  Throughout the 4 years of enrolment, HIV prevalence remained constant in three surrogate measures of recent HIV infections: women <20 years (16%), in primigravid women (18%), and in women aged 15-24 years (26%).  HIV infection was associated with elevated socio-economic status ([SES]; c²_(trend)=20.17, p<0.0001), marital status (c²=37.8, p<0.0001), and age (c²=160.6, p<0.0001), but it was not associated with maternal education level (c²_(trend)=1.22, p=0.27).  Muslim women (ethnic Yao) had a lower HIV prevalence than women of all other ethnicities (OR: 0.78, 95%CI: 0.64 - 0.95). Women with peripheral Malaria had a higher HIV prevalence than those without Malaria (OR: 1.27, 95% CI: 1.0 – 1.61).  Similarly, women who were syphilis seropositive had a higher HIV prevalence than syphilis seronegatives (OR: 2.08, 95%CI: 1.54 – 2.81). In contrast to HIV, an increased level of maternal education was associated with a decrease in the prevalence of syphilis (c²_(trend)=17.1, p<0.0001). 

Conclusions: Although the prevalence of HIV in the youngest women remained stable over the course of the study, the seroprevalence of HIV and syphilis among ANC attendees remains high.  The observation that syphilis and HIV infections differentially associate with education level may reflect the availability of HIV treatment compared to syphilis treatment.  Finally,  demographic and clinical correlates of HIV infection identified in this study should aid future studies to identify pregnant Malawians at a high risk of HIV infection.