• 3
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  • Disparities in Prenatal HIV Testing: METHODS

Study Population and Procedures

The sample comprised pregnant and postpartum women (<3 months after delivery) enrolled in the Massachusetts Women, Infants and Children (WIC) Program in 2001. WIC clients are not counseled about HIV testing or referred for prenatal HIV testing.

We used a two-step sampling procedure. First, we selected WIC clinics in Massachusetts in the areas with the highest percentage of HIV-positive women of childbearing age. Selected clinics had an enrollment of > 100 women who were pregnant or up to three months postpartum. From this initial pool of 20 clinics, six clinics agreed to be in the study.
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Table 1. Self-Reported Demographic and Social Characteristics of Respondents by Race/Ethnicity-Massachusetts, 2001

Race n (%)
Black/Haitian1 169 (39.0) Hispanic 119(27.5) White2 145 (33.5)
Demographic CharacteristicsAge in years

14-21

22-29

30-47

46 (27.9) 62 (37.6) 57 (34.5) 52 (44.4) 46 (39.3) 19 (16.2) 36 (25.7) 62 (44.3) 42 (30.0)

Currently married (yes)

65 (38.9) 69 (59.0) 96 (68.6)
Education <12 years3High-school graduate >12 years 22 (13.3) 76 (46.1) 67 (40.6) 39            (35.8)40    (36.7)

30 (27.5)

26 (18.4) 59 (41.8) 56 (39.7)
Pregnancy-Related Characteristics Prenatal care site community health center Hospital outpatient clinic MD office/HMO Other 47 (27.8) 78 (46.2) 33 (19.5) 11 ( 6.5) 54 (45.4) 37 (31.1) 20 (16.8) 8 ( 6.7) 33 (22.8) 16 (11.0) 88 (60.7) 8 (5.5)
Healthcare Access Health insurance (no) 29 (17.9) 7 (6.0)

7(5.1)

Stressful ExperiencesIntimate partner violence <12 months 9 (5.4) 5 (4.2)

8 (5.6)

1 For statistical efficiency, we grouped women as black that self-identified as Haitian, West Indian, African-American or Cape Verdean; 2 White women serve as the reference group; 3 Includes 43 women <21 years of age

All participating clinics were in urban areas, five from the eastern part of the state and one from the western part of the state. Together they provided access to a sample that mirrored the racial/ethnic composition of the state’s female HIV-infected population in 2001, which was 36% non-Hispanic black, 34% non-Hispanic white, 28% Hispanic and 2% other race or unknown.
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Second, WIC staff approached eligible Hispanic, black and white women and explained the study. Excluded were those clients who were not fluent in English, Spanish or Haitian Creole (the study languages). A $10 gift coupon was offered to respondents. Women provided written informed consent and then completed a self-administered questionnaire that took approximately 15 minutes. The Massachusetts Department of Public Health Institutional Review Board approved the study protocol.

MEASURES

The survey included questions from the CDC Perinatal Guidelines Evaluation Project HIV and Preg nancy Study surveys and CDC’s 1999 Pregnancy Risk Assessment Monitoring System (PRAMS) survey, including CDC PRAMS questions on partner-perpetrated physical and emotional abuse. Questions were pilot-tested for comprehension with women who were representative of the study sample.

Table 2. Self-Reported HIV-Related Test Barriers, Beliefs and Knowledge by Race/Ethnicity—Massachusetts, 2001

Race n (%)

Black/Haitian1            Hispanic 169(39.0)               119(27.5)

Questions (Yes response)

White2 145 (33.5)
Barriers1. If the test for HIV showed you had the AIDS virus would you be worried that… Someone close to me would know results?          57 (35.0)                40 (34.8) Husband/partner would hurt or leave me?          32 (18.9)                28 (23.5) MD would not keep test results secret?               33 (20.5)               27 (24.1) Children would be taken away?                       14 ( 8.8)                35 (30.7) 25 (18.1) 18 (12.4) 22(15.8) 9 ( 6.5)
Beliefs2. Should all pregnant women be tested for HIV? 138 (83.6)              140 (88.9) 110 (76.4)
Knowledge3. Can a pregnant woman infected with HIV pass the AIDS virus to her baby during… Pregnancy?                                               139 (82.7)               91 (78.4) Delivery?                                                   87 (52.1)                57 (50.4) Breastfeeding?                                            92 (55.1)                58 (50.4) 114 (80.3) 75 (52.8) 64 (45.4)
4. Is there a medicine a pregnant woman with HIV can take that may stop the AIDS virus from passing to her baby?                                                94 (56.3)                55 (47.8)             71 (50.4)
1 For statistical efficiency, we grouped women as black that self-identified as Haitian, West Indian, African-American or Cape Verdean; 2 White women serve as the reference group.

We assessed women’s reports of HIV counseling during their most recent pregnancy or shortly after giving birth by a “yes” response to one of six items. Women’s report of HIV testing (outcome variable) was documented if it occurred at any point during pregnancy.

Shown in Table 2 are the items measuring women’s self-report of HIV-related testing barriers, beliefs and knowledge. Women were asked if they knew their HIV status but were not asked to report their serosta-tus because of possible conflicts with Massachusetts confidentiality law. Source your medication needs online. Buy generic cymbalta home delivered

Statistical Analysis

Race and ethnic differences were calculated by cross-tabulation using the Chi-squared test (Tables 1 and 2). The 95% confidence intervals around the proportion of women counseled about the HIV test and tested show the range of values within which the percentage of women counseled and tested would lie (Table 3).

Table 3. Probability of Being Counseled about HIV Test and Tested for HIV by Site of Care and Race

Prenatal Care Site

Black/

Hispanic

White Percent Difference Percent Difference
Haitian Black/Haitian vs. Hispanic vs. White
White (95% CI) (95% CI)
Community health center

% Counseled about HIV test

43 (91.5)

51 (94.4)

30 (90.9) +0.6 (-0.4, 1.5) +3.5 (-0.8, 4.3)

% Tested

40 (85.1)

45 (83.3)

23 (69.7) + 15.4 (1.4, 16.9) + 13.6 (12.2, 14.9)

% Tested if counseled about test

37 (78.7)

43 (79.6)

23 (69.7) +9.0 (7.4, 10.6) +9.9 (8.5, 11.3)
Hospital outpatient clinic

% Counseled about HIV test

69 (88.4)

36 (97.3)

15 (93.7) -5.3 (-6.3, -4.3) +3.6 (2.3, 4.8)

% Tested

54 (69.2)

32 (86.5)

9 (56.3) + 12.9 (11.1, 14.7) +30.2 (27.7, 32.7)

% Tested if counseled about test

53 (67.9)

32 (86.5)

9 (56.3) + 11.6 (9.8, 13.4) +30. 2 (27.7, 32.7)
MD office/HMO

% Counseled about HIV test

30 (90.9)

15 (75.0)

68 (77.3) + 13.6 (12.8, 14.5) -2.3 (-3.6, -0.1)

% Tested

23 (69.7)

9 (45.0)

56 (63.6) +6.1 (4.9, 7.3) -18.6 (-20.2,-17.0)

% Tested if counseled about test

22 (66.7)

9 (45.0)

54 (61.4) +5.3 (-0.7, 11.3) -16.4 (-9.6, -23.1)
1 For statistical efficiency, we grouped women as black that self-identified as Haitian, West Indian, African-American or Cape
Verdean; 2 White women serve as the reference group.

Multivariable linear regression analyses were used to estimate proportional differences in prenatal HIV (еreating HIV infection when used in combination with other medicines) testing for the total sample and stratified by race. For ease of interpretation, proportional differences are reported as estimates of percents, with 95% confidence intervals derived from standard errors of beta estimates.

In the total sample model (Model 1: All women), all terms were entered into the linear regression model simultaneously. Each racial category was coded as a binary variable, with white women serving as the reference group. Other covariates included (♦indicates reference group): age (14-21, 22-29, 30-47); currently married (yes, no); monthly household income (<$ 1,000, $1,000 to $1,999, >$2,000, unknown); recent victim partner violence (yes, no); belief that all pregnant women should be tested for HIV (yes, no); pregnancy status at the time of data collection (first trimester, second trimester, third trimester, trimester unknown, postpartum); and three types of prenatal care sites [community health center, hospital outpatient clinic, private/health maintenance organization (HMO)].

Next, we conducted race-specific analyses using the same covariates in each model (Model 2: Black/Haitian women, Model 3: Hispanic women, Model 4: White women). Since the likelihood of being tested for HIV (treating HIV infection) was, in part, dependent on receiving counseling, we ran all models with and without prenatal HIV (treating HIV infection) counseling as a covariate.

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