title: Spatial pattern of HIV-1 mother-to-child-transmission in Madrid (Spain) from 1980 till now: demographic and socioeconomic factors.
abstract: OBJECTIVE
  To evaluate any possible association between indicators of social inequalities and the geographical distribution of HIV-1 mother-to-child transmission (MTCT) cases in Madrid.
  
  
  METHODS
  We carried out an observational survey of 224 HIV-1 vertically infected children born in 1980-2006 living in Madrid. We elaborated maps representing the prevalence of HIV-1 MTCT cases. We assessed the association between indicators of social inequalities and the spatial distribution of MTCT cases. Poisson univariate and multivariate analysis of risk factors for MTCT were performed.
  
  
  RESULTS
  We identified core areas of transmission mainly in southern Madrid until 2006. The prevalence of MTCT cases was significantly correlated to the percentage of immigrants, illiterates, unemployed women and the income in 1996 and 2000/2001. The risk of MTCT increased in the periods up to 1996 compared with the calendar period 1980-1989, whereas the risk decreased in 1999-2006 [relative risk, 0.08; 95% confidence interval (CI), 0.03-0.18; P < 0.001]. The risk was especially high in the districts of Usera (absolute relative risk, 11.4; 95% CI, 2.6-49.5; P = 0.001), Puente de Vallecas (absolute relative risk, 14.0; 95% CI, 3.4-57.9; P < 0.001) and San Blas (absolute relative risk, 12.5; 95% CI, 2.9-53.6; P = 0.001). The percentage of illiterates was the indicator that explained the risk of MTCT (absolute relative risk, 1.07; 95% CI, 1.05-1.10; P = 0.001).
  
  
  CONCLUSIONS
  We observed a geographic heterogeneity of the HIV-1 vertical transmission with the highest prevalence in disadvantaged districts. What is described in the present review is the HIV-1 vertical transmission within a social context; this approach could be relevant in analysing the pattern of HIV-1 transmission in other Western cities or highlighting the distribution of other infectious diseases.
authors.affiliation: Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Palladino
authors.forename: Jose María
authors.initials: JM
authors.lastname: Bellón
authors.forename: Santiago
authors.initials: S
authors.lastname: Perez-Hoyos
authors.forename: Rosa
authors.initials: R
authors.lastname: Resino
authors.forename: Sara
authors.initials: S
authors.lastname: Guillén
authors.forename: Dolores
authors.initials: D
authors.lastname: Garcia
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Gurbindo
authors.forename: José Tomás
authors.initials: JT
authors.lastname: Ramos
authors.forename: María Isabel
authors.initials: MI
authors.lastname: de José
authors.forename: María Josefa
authors.initials: MJ
authors.lastname: Mellado
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Muñoz-Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult