UCSD Study Focused on Pregnant Women
Cheryl Clark, SignOnSanDiego, Feb. 11
A surprising study of women in labor at one major Tijuana hospital that serves the poor found 1.2 percent — or about 48 mothers per year — are infected with the AIDS virus, researchers reported yesterday.
The rate is 10 times higher than at the University of California at San Diego, which conducted the study.
“This was an eye-opener for us,” said Dr. Rolando Viani, assistant pediatrics professor who helped design the study. “It points to the urgent need for counseling and testing” of other groups of pregnant women along the Mexican border.
Women who are unknowingly HIV-positive can pass the virus to their newborns. But if they are aware early in pregnancy, they can take combination therapies and reduce the risk of transmission to below 2 or 3 percent, Viani said.
Throughout San Diego County, the rate of HIV-positive women giving birth is about three in 5,000, or 0.6 percent, similar to the California average, according to 1998 testing of newborns. Drug therapy by the second trimester has allowed the University of California San Diego to prevent mother-to-child transmission in all 200 infected women it has treated over the last nine years, said study co-author, Dr. Stephen Spector.
The spread of HIV among women of child-bearing age in Mexico translates to a problem for San Diego because many infected Latinas seek care at UCSD’s maternal-child HIV clinic, he said.
Dr. Ruiz Calderon, who directs the clinic for HIV-infected women and children at the Tijuana General Hospital where the women were tested, called the results “amazing, something we certainly didn’t expect.”
The study was presented yesterday at the Retroviruses and Opportunistic Infections conference in San Francisco.
Calderon said the hospital plans to “show this data to Mexican officials. Maybe they will change their opinions about this problem and give us more medical resources.” The program is the only one of its kind in Tijuana, where HIV testing for pregnant women is rarely done.
AIDS education programs targeting doctors and other health providers are especially needed, he said, “because most of them think this is a problem that does not exist” to a significant degree.
Spector said there is apathy on both sides of the border.
“The feeling is 1 percent is not a big deal when you’re looking at Africa, which has infection rates of 30 to 40 percent,” he said. “But we’re very concerned this is an evolving problem that will substantially increase, and we now have an opportunity to intervene.”
The state-funded study was conducted during 13 weeks last summer when Calderon and other Tijuana physicians asked 981 women who came to the hospital while in labor to be tested for HIV. Nearly all, 96.7 percent, consented. Those who knew they were HIV-infected were not included.
Of the 947 women who didn’t know they had HIV, 12 were confirmed infected by antibody and viral testing. Extrapolating that number to a full year, the researchers estimate 48 pregnant women are unknowingly HIV-infected. The infected women reported such high-risk behaviors such as intravenous drug use and sex with more than five partners.
As they gave birth, the women were given AIDS drugs and told to refrain from breast-feeding to prevent transmission to their newborns. Still, two of the mothers passed the virus to their infants.
Dr. Gabriel Garcia Noriega, assistant medical director of the Tijuana hospital, cautioned that the study’s conclusions should not be extended to Tijuana as a whole, or to Baja or Mexico in general.
“This study was done in just one section of the population that avails themselves to the general hospital,” he said. It would be wrong to make policy decisions about pregnant women in Mexico without corroborating the results with future surveys, he said.
“Mexico is not ignoring this problem, which it certainly is,” he said. “But we have other health problems that are as important or more important than HIV right now.”
The researchers emphasized that many of the women who were infected didn’t have prenatal care, pointing for the need to expand counseling and testing programs months before the women are ready to deliver.
UCSD has monitored HIV-infected children at the Tijuana hospital for five years and last March expanded to women attending the prenatal clinic.
Because 40 percent of women who give birth at that hospital do not get prenatal care, the study was expanded to all women in active labor at the hospital.
Two years ago, a California-funded study tested 249 Tijuana men between age 18 and 29 who frequented gay dance clubs, bars and cruising areas. It found HIV infection rates as high as 35 percent, much higher than similar groups of high-risk gay men tested in San Diego or other major California cities.
According to Mexican health officials, Baja California has 62 cases of AIDS per 100,000 residents, the highest rate in Mexico.