Prevalence of HIV among pregnant women in Dundee 1988-1997: Evidence to gauge the effectiveness of HIV prevention measures

Objectives: During November 1988-July 1990, an HIV prevalence survey of pre gnant women in Dundee, which used a combined voluntary diagnostic testing a nd voluntary unlinked anonymous approach, revealed a rate of 0.3%, the high est recorded prevalence among such a population in the U.K. at the time. To determine if, and why, any changes in HIV prevalence had occurred during t he early to mid 1990s, further studies were conducted. Methods: During January 1993-December 1997, antenatal patients of, and wome n undergoing therapeutic termination of pregnancy at, Ninewells Hospital, D undee, were offered a diagnostic HIV antibody test. For those declining, re sidual sera from rubella specimens were tested for HIV antibodies using an unlinked anonymous approach which did not necessitate the securement of inf ormed consent. Information about injecting drug use was obtained from all w omen and linked to their HIV test results. Results: For all pregnant women, a significant decline in HIV prevalence (P <0.05) from 0.3% (19/6228) during 1988-1390 to 0.12% (22/17899) during 1933 -1997 was observed. For those who injected drugs, prevalence decreased sign ificantly (P<0.05) from 27.5% (11/40) to 7% (6/85), while among women who h ad never injected drugs prevalence decreased slightly but not significantly (P > 0.05), from 0.13% (8/6188) to 0.09% (16/17 814). Prevalence in the non-injectors who reported no sexual intercourse with an injector was tow at 0.04% (5/17 682) during 1993-1997, No significant trend s in HIV prevalence were seen over the 5 years up to 1997. Conclusion: The decline in HIV prevalence among pregnant women in Dundee du ring the early to mid-1990s can be explained predominantly by the control o f HIV transmission among the city's injectors, and from them to the wider h eterosexual population. It is likely that interventions designed to reduce needle/syringe sharing among injectors have been successful. It is imperati ve that the preventive effort is not allowed to be weakened. (C) 2000 The B ritish Infection Society.