Risk factors for HIV infection overlooked in routine antenatal care.

We have ascertained the extent to which risk factors for HIV infection may escape detection by standard history-taking procedures in an antenatal clinic. This study was based on 1264 women from a multi-ethnic population in an inner London health district (City and Hackney). All had agreed to undergo attributable HIV testing and a detailed personal interview. Thirty-nine per cent (494 of 1264 women) reported risk factors contributed personally or by a partner. Most of these risk factors had not been earlier disclosed by routine history taking. In most cases the risk was residence and risk activity in a World Health Organization (WHO) Pattern 2 country. [HIV spread WHO categories: Pattern 1--principally homosexual/bisexual males and i.v. drug use (areas = North America, Western Europe, Australasia, parts of South America) with male to female ratio 10/1; Pattern 2--Heterosexual (areas = Sub Saharan Africa, Caribbean and part South America) with male to female 1/1.] Thirty-one subjects (2.4%) were aware that their partners had participated in bisexual activity. Only six subjects perceived themselves at risk through their own or partner's drug injecting activity. The frequency of risk factors was substantially greater than that ascertained by the routine history. The findings highlight the potential risk of heterosexual spread resulting from travel to or residence in high prevalence territories. The contribution by male partners is significant and is particularly difficult to detect during a routine interview. These data support the recommendation that voluntary HIV serum testing should be universal rather than a selective offer based on risk factors determined at a routine history.