Study Of HIV/AIDS In Women Of Childbearing Age And The Affecting Factors Of Prevention Of Mother-to-child Transmission In Liangshan Yi Area

Liangshan Prefecture, the largest Yi ghetto of China, is now one of the most serious infected areas because of the rapidly development of AIDS, since the first case of HIV infection due to needle sharing reported in1995. A rapid growth trend is also appeared in Zhaojue County, the original state capital. Because of the traffic inconvenience, economic and cultural backwards, the residents have a poor understanding of the dangerous of AIDS. With the increase of proportion of sexual transmit these years, a lot of women infected, but didn’t take the detection. Or they have sex, pregnant and give birth to children without any protection even after the infection was told, so the number of children infected of mother-to-child transmission increase rapidly. Then they will be trapped in a vicious circle of birth-infection death-birth again since the premature dead of HIV infected children. That is a serious sociological problem and also makes the carrying out of prevention of mother-to-child transmission (PMTCT) extremely difficult. We developed the cross-sectional survey of HIV infection and reproductive status of women of childbearing age, qualitative interviews on the influencing factors of PMTCT, draw up interventions based on the findings and carried out an on-site intervention trial in the selected2township, and we also selected another control township to evaluate the interventions and effects. The entire study is divided into three parts:Part I The cross-sectional survey of HIV/AIDS and reproductive status of women of childbearing age in Liangshan Yi areaObjective To understand the HIV/AIDS and reproductive status of women of childbearing age, and providing the basis data for the PMTCT intervention in Liangshan Yi area. Methods Two townships of Zhaojue County were selected as the study field in Liangshan Yi Areas, and all women of childbearing age were detected and surveyed using a questionnaire for social demographic data, the HIV infection-related risk factors. Results A total of1826women of childbearing age were investigated, and most of whom were illiterate, with an average age33.77±7.89years.70HIV/AIDS cases were found in2townships with an average infection rate of3.83%. And there were an average infection rate of6.35%in the township2. The highest’infection rate of administrative villages was up to9.52%, and the infection rate of the group aged35-40was up to5.69%.23individuals infected with HIV (32.86%) were firstly found, compared with47(67.14%)previously found, including 6AIDS patients (8.57%).The separated/widowed rate of the infected population was higher than that of the uninfected (χ2=2.91, P<0.001). The proportion of venereal history of the new found infected population was higher than that of the previous infections(P=0.001). The total fertility rate of women of childbearing age was4.38, of which HIV-positive women’s (3.28) are lower than the negative women’s (4.42). Conclusions The high prevalence of HIV/AIDS of women of childbearing age, high tech detection rate, and the high total fertility rate suggests the presence of a higher risk of HIV mother-to-child transmission.Part II Qualitative study on affecting Factors of mother-to-child transmission in Liangshan Yi AreaObjective To analyze the affecting factors of prevention of mother-to-child transmission (PMTCT) in Liangshan Yi area. Methods Responsible people of health agencies, obstetricians and gynecology medical staff, HIV-positive and HIV-negative women of childbearing age were selected to participant in individual in-depth interviews. Results A total of103subjects were selected to attend the interviews. Traffic inconvenience, family economically disadvantage and poor knowledge of hazard of MTCT were the leading factors of the eight aspects which influenced the PMTCT. The contradiction between illegal birth and new rural cooperative medical system and feeding health problems were another two special factors of PMTCT. Conclusion Strengthen the maternal and child health service capacity of township hospital, provide special Medicaid to HIV positive pregnant women and promote the missionary of the hazard of MTCT.PART III Study of preliminary HIV prevention of mother-to-child transmission interventions and their effect in Liangshan Yi areaObjective To verify the factors of Mother-to-Child Transmission of HIV which have been found in previous study and establish a suitable and effective model for the prevention of mother-to-child Transmission (PMTCT) in Liangshan Yi area. Methods Formulate the PMTCT interventions according to the results of the qualitative research. Two townships were selected to take the implementation of "face-to-face" missionary in the Yi language,"man to man" hospital delivery promotion and appropriate economic incentives on the basis of the conventional ones. Another control one was sampled, one of which was to take the conventional PMTCT interventions. Results The rose of prenatal care rate (χ2=16.33, P<0.001) and hospital delivery rate (χ2=17.87, P<0.001) of intervention township was significantly higher than the control one,1.30times and2.25times of which respectively; the overall maternal HIV infection rate was in an upward trend; The positive maternal hospital delivery rate (χ2=A.63, P=0.031), maternal antiviral treatment rate (χ2=4.63, P=0.031) and a baby antiviral treatment rate (χ2=6.36, P=0.012) were all increased compared with before, which reached to80.95%. Conclusion The interventions formulated according to the previous study were effectively improved the hospital delivery rate, the HIV detection rate and antiviral treatment rate, and thus it’ll reduce the mother-to-child transmission rate. It indicates that the affecting factors found are accurate and the interventions are effective.