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Study: HIV Births at Tijuana Hospital Ten Times Higher Than UCSD
http://www.kfmb.com/topstory22293.html
(02-11-2004) - About 48 women who deliver babies at Tijuana General Hospital are found each year to be infected with HIV, a rate 10 times higher than
at UCSD Medical Center, according to a UCSD School of Medicine study.
The study showed that 1.26 percent of the 947 women in labor at the hospital tested positive for HIV between June and September 2003. Mexican
officials previously estimated HIV infection among pregnant women at only 0.09 percent.
In San Diego County, the rate of HIV-positive women giving birth is about 3 in 5,000, or 0.6 percent, similar to the California average, officials
said.
Researchers are concerned with the findings because many infected women from Mexico come across the border to have their children and seek treatment
at UCSD's maternal-child HIV clinic, the study reported.
"The key to preventing HIV infection in children is the identification and treatment of pregnant women who are HIV positive," said Dr. Rolando Viani,
UCSD assistant professor of pediatrics. "Unfortunately, HIV testing during pregnancy is not routinely done at Tijuana General Hospital."
The study was presented yesterday at the 11th Conference of Retroviruses and Opportunistic Infections in San Francisco.
Researchers plan to show their findings to Mexican officials in hopes of gaining more resources for hospitals in Baja California. HIV testing is
rarely done for pregnant women in Tijuana, researchers said.
Researchers found that the vast majority of women in labor were willing to undergo HIV counseling and rapid-result testing.
Mexico ranks third in the Americas for AIDS cases, with about 30 cases per 100,000 residents. The highest rates of AIDS are in Baja California -- 62
cases per 100,000 residents.
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http://ucsdnews.ucsd.edu/newsrel/health/02_10_Viani.asp
February 10, 2004
By Sue Pondrom
HIV infection among pregnant women in labor at Tijuana General Hospital in Mexico is 14 times higher than previously reported by CONASIDA, the Mexican
organization that tracks AIDS cases, according to a study conducted by physicians at the University of California, San Diego (UCSD) School of
Medicine.
Presented at the 11th Conference on Retroviruses and Opportunistic Infections Feb. 10, 2004 in San Francisco, California, the study found a 1.26
percent HIV infection rate among 947 women in labor tested during June through September 2003. CONASIDA had estimated the prevalence of HIV infection
at only 0.09 percent among pregnant Mexican women.
?The key to preventing HIV infection in children is the identification and treatment of pregnant women who are HIV positive,? said Rolando Viani,
M.D., UCSD assistant professor of pediatrics, who presented the findings at the conference. ?Unfortunately, HIV testing during pregnancy is not
routinely done at Tijuana General Hospital.?
The researchers found that the vast majority of women in labor (96.7 percent of those asked) were willing to undergo HIV counseling and rapid-result
testing. When a woman in active labor was found to be HIV positive, she was given the drug zidovudine (ZDV, AZT) intravenously, and was advised to
refrain from breast feeding, which is a means of transmitting the disease to her infant. Within the first week of life, the newborn was tested for
HIV, with repeat tests at four weeks, two months and four months. The child also received zidovudine orally for six weeks. In addition to the test in
labor and delivery, the women were given follow-up tests to confirm the diagnosis after delivery.
The problem of HIV/AIDS in Tijuana doesn?t stop at the border, added Stephen Spector, M.D., chair of the executive committee of the National Pediatric
AIDS Clinical Trial Group, chief of the UCSD Division of Pediatric Infectious Diseases, and director of UCSD?s Mother, Child & Adolescent HIV Program,
which oversaw the UCSD study at Tijuana General Hospital.
The Tijuana/San Diego border crossing is the busiest land port of entry in the world with more than 131,000 legal border crossings daily. Because so
many people cross the border on a daily basis, and since Mexicans frequently seek medical care and consultation in the United States, San Diego is
impacted by the rate of HIV infection in Tijuana, Spector noted.
?Our maternal-child HIV clinic at UCSD is about 50 percent Latinas,? Viani said. ?Of these women, 95 percent are of Mexican descent. This points to
the problem that spills over on both sides of the border.?
Mexico ranks 3rd in the Americas for AIDS cases with 29.9 cases per 100,000 residents. According to CONASIDA, the highest rates of AIDS are in Baja
California with 62 cases per 100,000 residents. Although the rates of HIV infection are unknown, they are likely to be more than 10-fold greater than
the reported number of AIDS cases.
In 2002, the California Department of Health Services released a study among high-risk men who have sixx with men in Tijuana and San Diego. The
two-year study revealed that 43 percent of Tijuana men reported unprotected heterosexual intercourse and 25 percent reported sharing needles in the
previous four months. Furthermore, 39 percent of men reported having sexual partners from across the border in their lifetime.
?We can?t solve the problem of HIV/AIDS in San Diego unless we work with the problem in Tijuana,? Spector said. He added that ?the false perception is
that compared to HIV/AIDS in Africa, there isn?t a problem in Mexico.?
Fortunately, several Tijuana physicians recognized the need to stop HIV transmission in their border communities, and began meeting with Spector and
Viani in a bi-national effort to develop programs for HIV positive mothers and children. The program in Tijuana became an extension of the successful
15-year-old UCSD Mother, Child and Adolescent HIV Program that has provided comprehensive HIV care to pregnant women, children and teens. As a result
of the UCSD program, there have been no transmissions of HIV from mother to child in women followed by the UCSD program in the last nine years.
However, some pregnant women, even in San Diego, who have gone undiagnosed, have still given birth to HIV-infected infants during this period.
For the past five years, the UCSD team has followed pediatric HIV patients at Tijuana General Hospital and last March began HIV testing for women
attending the hospital?s prenatal clinic. However, since 40 percent of women who deliver at the hospital have never had prenatal care, in June the
UCSD and Tijuana General Hospital physicians expanded the testing to all women in active labor who arrive at the hospital.
The prenatal counseling and testing at Tijuana General Hospital was first funded by the National Institutes of Health (NIH) and the Center for AIDS
Research (CFAR) at the UCSD School of Medicine. Current funding comes from CFAR and the University of California?s Universitywide AIDS Research
Program, which funded the study presented at the Retroviral Conference.
# # #
Additional findings from the UCSD study:
Compared to HIV-negative mothers, HIV infected women were more likely to use IV drugs or other drugs (17 percent vs 2 percent), have more sex partners
(3.8 vs. 2.8), not seek prenatal care (53 percent vs. 23 percent), have a partner who uses IV drugs (25 percent vs. 5 percent) or a partner who uses
other drugs (42 percent vs. 14 percent).
The UCSD Mother, Child and Adolescent HIV Program, which began in 1988, provides comprehensive HIV care to pregnant women, children, teens and
mothers. A multidisciplinary team of HIV specialists provides medical care, clinical trials, patient education, counseling, case management, and
community education. Women in the program learn all the various options that can help reduce the maternal/infant transmission and then are supported
in the choices they make. Since 1994, there have been no transmissions of HIV from mother to baby at UCSD Medical Center.
The program is part of the national Pediatric AIDS Clinical Trials Group (PACTG), the Adolescent Trials Network and the Ryan White Title IV Program
through U.S. Department of Health and Human Services. Dr. Stephen A. Spector, the program director of this UCSD program, is also chair of the PACTG
Executive Committee, which provides scientific leadership, sets policy, and allocates resources for studies within the PACTG.
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