|POST for antenatal care: Antenatal clinics commonly give women one or more tetanus vaccinations so their babies don’t get tetanus, and take venous blood to test for syphilis and/or anaemia.
|1. Avoid skin-piercing procedures
||(a) If a high percentage of adults in your community have HIV, consider going to a private provider for antenatal care. If so, choose a provider who will listen to your concerns, and will show you that what he or she does is safe.(b) Ask your provider if you can avoid tests taking venous blood. If a test is important, ask if it can be done some other way, such as with urine or finger prick blood.
|2. Use new disposable instruments
||(a) Bring new disposable syringes and needles for all injections and blood tests (see Injections section).(b) Take tetanus vaccine from a single-dose vial, or from a multi-dose vial opened for you (see Injections section). If you get more than one dose of tetanus vaccine during repeated antenatal visits, open a new vial each time. The vaccine saved in an opened vial can grow a lot of pathogens (germs) and can be very dangerous.
|3. You sterilize the instruments
||Not applicable. Use new disposables for everything.
|4. Ask providers how they sterilize instruments
||Not applicable. Use new disposables for everything.
Evidence women got HIV from antenatal care
A lot of evidence suggests antenatal care has infected many women in Africa over the years. Here are some things to consider:
The percentages of women HIV-positive in antenatal care are often far greater than can be easily explained by sexual risks. For example, in KwaZulu-Natal during 2013-17, more than 40% of women seen at antenatal care were HIV-positive (see page 68 in this link). Almost always, women in antenatal care in Africa are more likely to be HIV-positive than all adults in the community. How are women getting more HIV than men?
The rates at which women get new HIV infections during antenatal care (testing HIV-negative in antenatal care and then found to be HIV-positive weeks weeks later or at delivery) are at times far too high to be easily explained by sex. For example, in a study in Swaziland during 2008-9 pregnant women got new HIV infects at the rate of 16.8% per year (58 of 1,377 who tested HIV-negative in antenatal care were HIV-positive several months later when they delivered). At least 15 studies in 9 countries in Africa have reported pregnant and early post-partum (after delivery) women getting HIV at rates from 6.1% to 19% (or data to calculate those rate; see details and references in this link).
In many national surveys in Africa, women who received blood exposures during antenatal care (tetanus vaccinations and blood tests for syphilis and/or anemia) are more likely to be HIV-positive compared to women who were not exposed (see table below). Surveys asked women who gave birth in the last 5 years if they had received tetanus vaccinations and/or had given blood for tests during antenatal care. The surveys also tested women for HIV, making it possible to see if getting a tetanus vaccination or blood test was more common among HIV-positive than HIV-negative women.
In Kenya, for example, among women who had given birth within the last 5 years, women who had received tetanus vaccinations were 1.89 times more likely (89% more likely) to be HIV-positive compared to women who had not received tetanus vaccinations. Looking at results from 11 countries, women who had received a tetanus vaccination and/or had blood taken to test for syphilis and/or anemia were 1.28 times more likely (28% more likely) to be HIV-positive.
Table: Evidence pregnant women got HIV from tetanus vaccinations and blood tests
|Risk, country, year
||Relative risk to be HIV-positive among women with vs. without the specified procedure during antenatal care
|Tetanus vaccinations in Kenya, 2003
|Tetanus vaccinations in Cameroon, 2004; Ethiopia 2005; Ghana, 2003; Guinea, 2005; Kenya, 2003; Lesotho, 2004; Senegal 2005; Malawi, 2004; Rwanda, 2005; Zimbabwe, 2005-06
||Composite estimate for 11 countries: 1.19
|Giving blood for tests in the same 11 countries
|| Composite estimate for 11 countries: 1.23
|Tetanus vaccinations and/or giving blood for tests in the same 11 countries
|| Composite estimate for 11 countries: 1.28
1. Woldesenbet SA, Kufa T, Lombard C, et al. The 2017 National Antenatal Sentinel HIV Survey, South Africa, Pretoria: National Department of Health, 2019. Available at: https://www.researchgate.net/publication/334883856_The_2017_National_Antenatal_Sentinel_HIV_Survey_Key_Findings_South_Africa (accessed 22 February 2021).
2. Kieffer MP, Nhlabatsi B, Mahdi M, et al. Improved detection of incident HIV infection and uptake of PMTCT services in labor and delivery in a high HIV prevalence setting. J Acquir Immune Defic Syndr 2011; 57: e85-e91. Available at: https://journals.lww.com/jaids/Fulltext/2011/08010/Improved_Detection_of_Incident_HIV_Infection_and.18.aspx (accessed 22 February 2021).
3. Gisselquist D. Mixed signals: not investigating high HIV incidence in pregnant women in Africa. Social Science Research Network [internet] 2018. Available at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3153795 (accessed 22 February 2021).
4. Deuchert E, Brody S. The role of health care in the spread of HIV/AIDS in Africa: evidence from Kenya. Int J STD AIDS 2006; 17: 749-752. Abstract available at: https://pubmed.ncbi.nlm.nih.gov/17062178/ (accessed 22 February 2021).
5. Brewer DD, Roberts JM, Potterat JJ. Punctures during prenatal care associated with prevalent HIV infection in sub-Saharan African women. International Society for Sexually Transmitted Diseases Research, Seattle 2007. Available at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2813459 (accessed 22 February 2021).