HIV TESTING, KNOWLEDGE, ATTITUDES, BELIEFS, AND ... - NCBI

HIV TESTING, KNOWLEDGE, ATTITUDES, BELIEFS, AND PRACTICES AMONG MINORrTIES: PREGNANT WOMEN OF NORTHAFRICAN ORIGIN IN SOUTHEASTERN FRANCE Antoine Messiah, MD, PhD, Dominique Rey, MD, Yolande Obadia, MD, Michel Rotily, MD, and Jean-Paul Moatfi, PhD Marseille, France Since 1991, the French public health ministry has recommended that human immunodeficiency virus (HIV) testing be offered to all pregnant women. This study was undertaken to determine whether this recommendation is followed independently of a woman's ethnicity. It is based on a 1992 survey regarding knowledge, attitudes, beliefs, and practices on HIV infection and testing among pregnant women in southeastern France. Survey results revealed that North-African women (n=207) were more likely to have a low socioeconomic and educational level, receive their health care at public health institutions, and be less knowledgeable about HIV transmission than French women (n=2234). They were also more likely to have been tested for HIV without their knowing it and less likely to perceive themselves as being at risk. Consent to undergo HIV testing during pregnancy was dependent on their North-African origin after controlling for significant covariates. These results indicate that routine prenatal screening appears insufficient to ensure adequate HIV testing and counseling of women of ethnic minorities. The development of HIV prevention programs that are cultural-specific and that aim at increasing physicians' compliance with the official recommendation is needed. (J Nati Med Assoc. 1 998;90:87-92.)

Key words: * human immunodeficiency virus (HIV) * HIV transmission * minorities In France, as in most other industrialized countries, the proportion of women among the total number of registered acquired immunodeficiency syndrome (AIDS) cases has increased steadily since the beginning of the epidemic (from 13.9% in 1987 to 20.4% in 1995.1 Prenatal care is viewed as especially appropriFrom the South-Eastern French Center for Disease Control and the Institut Paoli-Calmettes, Marseille, France. This study was supported by the French Agency for Aids Research. Requests for reprints should be addressed to Dr Antoine Messiah, INSERM U-379, Institut Paoli Calmettes, 232 bd Sainte Marguerite, BP 156, 13273 Marseille Cedex 09, France. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 90, NO. 2

ate for general policies of human immunodeficiency virus (HIV) screening and counseling to reach all women.2 This is especially true in France, where the public social insurance system guarantees universal health coverage for all pregnant women living in the country. Since the early 1970s, a minimum of four free-of-charge prenatal care medical consultations (including testing for syphilis, rubella, and toxoplasmosis at the first visit) have been mandatory. It is widely accepted that this legislation greatly contributed to recent progress in prenatal care and prevention of preterm births and children's handicaps.3 In December 1991, the French Ministry of Health issued an official recommendation that general practitioners, gynecologists, and obstetricians systematically offer, an HIV test to all pregnant women consulting 87

HIV TESTING AMONG MINORITIES

Table 1. Sociodemographic Data and Conditions of Pregnancy, by Ethnic Group % NorthAfrican % French Women

Women

(n=207) (n=2234) P Value Age (years) 6000 francs Religion None or not practicing Practicing Prenatal care delivered by Private ambulatory physicians Public prenatal institutions No. of prenatal consultations