TRENDS OF HIV-1 AND SEXUALLY-TRANSMITTED DISEASES AMONG PREGNANT AND POSTPARTUM WOMEN IN URBAN MALAWI

Objectives: To examine rates of HIV-1 and sexually transmitted disease (STD) among pregnant and postpartum women in urban Malawi, Africa. De sign: Serial cross-sectional surveys and a prospective study. Methods: Three major surveys were conducted in 1990, 1993 and 1994/1995. Conse cutive first-visit antenatal women and women giving birth at the Queen Elizabeth Central Hospital were tested for HIV and STD after counseli ng and obtaining informed consent. Unlinked, anonymous HIV testing was also conducted on smaller samples of antenatal women in the same hosp ital to provide annual prevalence data. HIV-seronegative postpartum wo men from the 1990 and 1993 surveys were enrolled in a prospective stud y to determine HIV incidence. Results: HIV seroprevalence rose from 2. 0% in 1985 to 32.8% in 1996, a 16-fold increase. The highest age-speci fic HIV prevalence was in the following age-groups: 20-24 years during 1990, 25-29 years during 1993, and 30-34 years during 1996. Among 117 3 women followed for a median of 30.9 months, HIV incidence was 5.98 p er 100 person-years in women aged < 20 years and declined steadily in older women. The prevalence of STD significantly declined among both H IV-positive and negative women. This decline in STD prevalence, howeve r, was not accompanied by increased condom use over time. Conclusions: Among urban childbearing women in Malawi, incidence of HIV is highest among young women while, currently, prevalence is highest among older women. Recent declines in STD prevalence suggest that HIV prevention programs are having an impact either through improved STD diagnosis an d treatment or reduced risk behaviors. Sequential cross-sectional STD prevalence measures may be useful in monitoring effectiveness of STD a nd HIV prevention activities.