title: Low utilization of HIV testing during pregnancy: What are the barriers to HIV testing for women in rural India?
abstract: BACKGROUND
  Sixty percent of India's HIV cases occur in rural residents. Despite government policy to expand antenatal HIV screening and prevention of maternal-to-child transmission (PMTCT), little is known about HIV testing among rural women during pregnancy.
  
  
  METHODS
  Between January and March 2006, a cross-sectional sample of 400 recently pregnant women from rural Maharashtra was administered a questionnaire regarding HIV awareness, risk, and history of antenatal HIV testing.
  
  
  RESULTS
  Thirteen women (3.3%) reported receiving antenatal HIV testing. Neither antenatal care utilization nor history of sexually transmitted infection (STI) symptoms influenced odds of receiving HIV testing. Women who did not receive HIV testing, compared with women who did, were 95% less likely to have received antenatal HIV counseling (odds ratio = 0.05, 95% confidence interval: 0.02 to 0.17) and 80% less aware of an existing HIV testing facility (odds ratio = 0.19, 95% confidence interval: 0.04 to 0.75).
  
  
  CONCLUSIONS
  Despite measurable HIV prevalence, high antenatal care utilization, and STI symptom history, recently pregnant rural Indian women report low HIV testing. Barriers to HIV testing during pregnancy include lack of discussion by antenatal care providers and lack of awareness of existing testing services. Provider-initiated HIV counseling and testing during pregnancy would optimize HIV prevention for women throughout rural India.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA. gsinha 1@jhmi.edu
authors.forename: Gita
authors.initials: G
authors.lastname: Sinha
authors.forename: Ashok
authors.initials: A
authors.lastname: Dyalchand
authors.forename: Manisha
authors.initials: M
authors.lastname: Khale
authors.forename: Gopal
authors.initials: G
authors.lastname: Kulkarni
authors.forename: Shubha
authors.initials: S
authors.lastname: Vasudevan
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007194:India; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D012423:Rural Health; D011795:Surveys and Questionnaires