Risk Assessment for Human Immunodeficiency Virus among Pregnant Hispanic Adolescents
Berger, David K., Rivera, Miriam, Perez, Gloria, Fierman, Arthur, Adolescence
The number of persons reported with acquired immunodeficiency syndrome (AIDS) in the United States exceeded 200,000 by the end of 1991 (Centers for Disease Control, 1992). Adolescents and young adults 13-24 years of age accounted for 4-5% of both the total number of cases and the deaths reported (Centers for Disease Control, 1991; Manoff et al., 1989). Because human immunodeficiency virus (HIV) seropositivity may be present for 5-7 years before AIDS is manifest, many young adults with AIDS were probably infected as adolescents (Hein, 1989; Manoff et al., 1989).
Blacks and Hispanics have disproportionately higher rates of AIDS than do whites, and they have the highest rates of heterosexually acquired AIDS (Centers for Disease Control, 1989, 1990; Gayle, Selik, & Chu, 1990; Holmes, Karon, & Kreiss, 1990; Selik et al., 1989; Selik, Castro, & Pappaioanou, 1988; Vermund et al., 1989). Since men have greater seroprevalence, women are more likely than heterosexual men to have an infected partner and may also be unaware of their partners' status (Centers for Disease Control, 1989). Among adolescents, a higher percentage of cases is due to heterosexual transmission as compared to adults, 9% versus 4.9%, respectively (Centers for Disease Control, 1989; Holmes, Karon, & Kreiss, 1990; Manoff et al., 1989; Vermund et al., 1989). Inner-city teens are thought to be at increased risk for HIV infection because of their high-risk behaviors (Hein, 1989; Manoff et al., 1989; Weisman et al., 1989), and black and Hispanic adolescents may be at greatest risk as a consequence of these behaviors as well as inadequate AIDS education (DiClemente, Boyer, & Morales, 1988).
Certain information about HIV infection is well established. Transmission from mother to infant during the birth process accounts for most childhood HIV infection (Cowan et al., 1984; Friedland & Klein, 1987). The frequency of transmission from infected mothers is reported to be between 25% and 50% (Mok et al., 1987; Parks & Scott, 1987). Children and adolescents with HIV infection have extremely poor prognoses (Krasinski, Borkowsky, & Holzman, 1989; Scott et al., 1989). Seroprevalence studies indicate that rates of HIV infection are related to the study population's age, gender, race, ethnicity, high-risk behaviors, and geographic locale (Burke et al., 1990; Gayle et al., 1990; Hoff et al., 1988; St. Louis et al., 1990).
In the present study, HIV risk status among pregnant Hispanic adolescents presenting for prenatal care was assessed in order to determine which adolescents were at increased risk for HIV infection, to identify specific adolescent risk factors for HIV infection, and to determine whether demographic characteristics were associated with increased risk.
All pregnant Hispanic adolescents 13 through 19 years of age who registered for prenatal care at a medically oriented, municipal outpatient adolescent clinic located on the Lower East Side of New York City qualified for the study. The clinic serves a predominantly Hispanic, working-poor population, and all fees for prenatal care are covered by Medicaid or PCAP (Prenatal Care Assistance Program), a state-funded program.
The pregnant adolescents were routinely evaluated and followed up by a certified nurse midwife. Comprehensive prenatal care included several appointments with the team social worker and health educator. In May 1989, the health educator began routinely to perform structured HIV risk assessments on all pregnant teenagers during their counseling sessions.
The HIV risk assessment consisted of a confidential structured interview that evaluated the adolescent's risk for HIV infection. The interview focused on demographic information (age, ethnicity/nationality, birthplace, and school attendance), past and present medical histories, travel history, sexual history, substance use/abuse, and information about the father of the baby. …