Disparities in Prenatal HIV Testing: RESULTS
Our survey of 433 women with self-identified race and ethnicity revealed that most women were counseled about the HIV test (87.8%) and tested (70.2%). Of the 428 women for whom counseling status was known, 5% reported that they were tested prenatally but not counseled about HIV (treating HIV infection), and 18% reported that they were counseled about HIV but did not get tested during their pregnancy (Figure 1). The prevalence of prenatal HIV testing was higher among Hispanics (78.8%) than blacks (74.3%) or whites (65.0%) after adjustment for trimester or postpartum status (data not shown).
In this WIC population, income varied little by race. Most women reported incomes of <$2,000 per month. Hispanic women were younger, less formally educated and more likely to receive prenatal care in a community health center (Table 1). Black women were less likely to have any health insurance and more likely to receive prenatal care in a hospital outpatient setting. White women were more likely to receive prenatal care in a private practice setting (MD office/HMO).
Figure 1. Percentages of Women Knowledgeable about HIV Status, Counseled about HIV Test and Tested
While only a minority of respondents reported concerns about prenatal HIV testing, there were differences by race/ethnicity (Table 2). Compared with white women, black and Hispanic women were nearly twice as likely to express concerns about someone finding out if they tested positive for HIV (еreating HIV infection when used in combination with other medicines) Nearly one-third of Hispanic women, but <10% of black or white women, expressed concern that their children would be taken away if they had a positive HIV test. Most women endorsed the belief that all pregnant women should be tested for HIV, but the proportions differed by race, with more black and Hispanic women than white women expressing this belief (83.6%, 88.9% and 76.4%, respectively). A majority of respondents knew that an HIV-positive woman could pass the virus to her baby during pregnancy. Knowledge about other modes of mother-to-child transmission was low and differed little by race. Bivariate analyses of the probability of being tested by race/ethnicity and practice setting are presented in Table 3. Significant racial/ethnic differences emerged among the three sites (publicly fund ed and private). Hispanic women had a 14% higher probability of being tested for HIV (еreating HIV infection when used along with other medicines) in a community health center and a 30% higher probability of prenatal testing in a hospital outpatient clinic, compared with white women (Table 3). Only in the private practice setting (MD office/HMO) did Hispanic women have the lowest probability of prenatal testing (45%>). Relative to white women, black women reported a higher probability of testing in public and private practice settings. We found similar results when we considered testing with counseling.
In the multivariable regression analyses for the total sample, having a monthly income of <$ 1,000, receiving prenatal care in a community health center or hospital outpatient clinic, and believing that all pregnant women should be tested for HIV increased the probability of testing by 13.7%, 15.9%, 14.1% and 40%, respectively. In contrast, being in the first trimester of pregnancy at the time of the study and being a recent victim of intimate partner violence decreased the probability of testing by 12.2% and 9.3%, respectively. Race was not associated with testing (data not shown). Race-specific models suggested that different factors were associated with the probability of testing, with one exception. Positive beliefs about HIV screening were associated with more frequent prenatal HIV testing for black (30%), Hispanic (29%) and white women (54%). No other factors were associated with testing in the model for white women. For black women, being in the first trimester of pregnancy at the time of the study decreased the probability of testing by 26%. Being a recent victim of intimate partner violence was associated with a 17% lower probability of testing but, due to the small sample, the 95% confidence intervals are wide (95% CI= -37.0%-+3.9%, p=0.026). For Hispanic women, receiving prenatal care in a community health center or hospital outpatient clinic increased the probability of testing by 31% and 35%>, respectively.
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In the models of prenatal HIV testing adjusted for HIV counseling, there were distinct differences according to race. Being counseled about HIV testing increased the likelihood of testing by an estimated 47% for white women (95% CI=28.1-65.7%), 26.2% for Hispanic women (95% CI=-1.2-+53.6%) and 18.8% for black women (95% CI=-6.8- +44.4%).