title: High HIV incidence and sexual behavior change among pregnant women in Lilongwe, Malawi: implications for the risk of HIV acquisition.
abstract: BACKGROUND
  HIV incidence is higher among pregnant women than their non-pregnant counterparts in some sub-Saharan African settings. Our aims were (1) to estimate HIV incidence during pregnancy and (2) to compare sexual activity between pregnant, postpartum, and non-pregnant women.
  
  
  METHODS
  We examined a retrospective cohort of 1087 women to identify seroconverters using antenatal and labor ward HIV test results. We also conducted a cross-sectional survey, including a quantitative questionnaire (n = 200) and in-depth interviews (n = 20) among women in early pregnancy, late pregnancy, postpartum, and non-pregnancy. Outcomes included measures of sexual activity, reported spouse's risky behavior, and beliefs about abstinence.
  
  
  RESULTS
  11 of 1087 women seroconverted during pregnancy yielding a 1% seroconversion risk and an incidence rate of 4.0/100 person years (95% CI 2.2-7.2). The reported sexual activity of the early pregnancy and non-pregnancy groups was similar, but significantly higher than the late pregnancy and postpartum groups (p<0.001). During pregnancy, sex acts decreased as gestation increased (p = 0.001). There was no reported difference in the spouse's risky behavior. Most women believed that sex should cease between the 6(th) and 8(th) month of pregnancy and should not resume until 6 months postpartum. Some talked about conflict between their cultural obligation to abstain and fear of HIV infection if their spouses find other partners.
  
  
  CONCLUSIONS
  HIV incidence is high among pregnant women in Malawi, and sexual activity decreases during pregnancy and postpartum. Pregnant women need to be informed of their increased risk for HIV and the importance of using condoms throughout pregnancy and the postpartum period.
authors: University of North Carolina Project, Lilongwe, Malawi.
authors: Maria A
authors: MA
authors: Keating
authors: Gloria
authors: G
authors: Hamela
authors: William C
authors: WC
authors: Miller
authors: Agnes
authors: A
authors: Moses
authors: Irving F
authors: IF
authors: Hoffman
authors: Mina C
authors: MC
authors: Hosseinipour
mesh_terms: D000293:Adolescent; D000328:Adult; D003469:Culture; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008295:Malawi / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D012746:Sexual Abstinence / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D055815:Young Adult