Determination of the seroprevalence of human immunodeficiency virus infection in gravidas by non-anonymous versus anonymous testing.

From February 16, 1988 to July 15, 1988, a prospective study was undertaken at the University of Illinois Hospital in Chicago to do the following: 1) determine the seroprevalence of human immunodeficiency virus (HIV) infection among our gravid patients, 2) test the hypothesis that methodical counseling would elicit a more thorough recounting of risk factors, and 3) test the hypothesis that those patients who self-identify risk factors represent only a fraction of HIV-positive gravidas. After educational counseling regarding HIV infection, 349 clinic patients (34%) requested non-anonymous HIV testing (group I). Risk factor histories were recorded from these women. Simultaneously, 849 women admitted to labor and delivery were queried with regard to the same risk factors but without preliminary counseling, and then tested anonymously (group II). Nineteen percent (63 of 349) of group I reported risk factors, whereas only 9.6% (82 of 849) of group II reported similar risks (P less than .0001). Two HIV-positive patients were identified in group I, both of whom reported risk factors (seroprevalence 0.6%). Nine HIV-positive patients were detected in group II, but only four reported risk factors (seroprevalence 1.1%). We conclude that methodical counseling may elicit increased reporting of HIV risk factors as compared with questioning without preliminary counseling. Because many HIV-positive patients may be unable or unwilling to report risk factors, selective voluntary testing will not identify all HIV-positive gravidas.