Behavioral factors influencing mother-to-child transmission of HIV.

다국어 초록 (Multilingual Abstract)

<italic>Background</italic>. HIV Mother to child transmission (MTCT) substantially contributes to high levels of infant/child morbidity and mortality in sub-Saharan Africa. The rate of MTCT is associated with demographic, biologic, and behavioral risk factors. Sexual behaviors of HIV positive women and their partners may influence MTCT through STD acquisition and increases in viral shedding. Multiple partners and frequency of sex in the third trimester have been shown to be positively associated with MTCT. Choices of infant feeding regimen influence postnatal MTCT since HIV can be transmitted through breast milk. Formula feeding has been shown to protect an infant from postnatal MTCT, but may not confer the same health benefits as breast milk. Exclusive breastfeeding has been shown to be protective over mixed feeding in MTCT.
<italic>Design</italic>. Behavioral data were collected in a MTCT randomized clinical trial in Malawi.
<italic>Outcome measures</italic>. HIV negative status was defined as an infant who was HIV negative at the six week visit; intrauterine transmission (prevalent infection) was defined as infants who were HIV positive at birth; while intrapartum and early postnatal transmission (incident infection) was defined as an infant negative at birth and positive at six weeks.
<italic>Results</italic>. Overall, 1098 infants born to HIV positive mothers were included in this analysis. Infant HIV incident infection was found to be positively statistically associated with number of wives the infant's father has. A mother's frequency of sex in the third trimester was found to be marginally statistically inversely associated with MTCT. No differences were seen between exclusive breast feeders and mixed feeders in MTCT in the early postnatal period.
<italic>Conclusions</italic>. This analysis found higher risk for intrapartum MTCT if the pregnant woman's partner had multiple partners. The protective effect on MTCT seen in women reporting higher frequency of sex in the third trimester may be due to a corresponding lower number of sexual partners their partner had during this time period. This analysis shows that the sexual behaviors of a pregnant woman's partner are influential in MTCT. Education on safer sex, condom distribution, and aggressive diagnosis and treatment of STDs should be offered in the antenatal setting.