Making a Choice: The Role of Education in Prenatal HIV Screening Among Pregnant Women in Georgia Open Access

Abstract

Over the past twenty years, prevalence of the human immunodeficiency virus (HIV) has grown substantially among women such that 25% of all HIV cases are now among women. This poses a unique challenge to childbearing women, as vertical transmission from mother to child during pregnancy is the primary mode of HIV transmission among children. Although current US guidelines recommend universal HIV screening during pregnancy using an opt-out testing program, so that all women are tested for HIV unless they explicitly refuse, a significant portion of pregnant women in the United States do not receive prenatal HIV testing. Yet few studies have examined demographic characteristics that may influence a mother's receipt of prenatal HIV testing. By analyzing a representative sample of women from Georgia who participated in the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2004 to 2008, the objective of this project is to examine demographic predictors of HIV testing among pregnant women, focusing specifically on maternal education level. Based on an adaptation of Cheryl Cox's Interaction Model of Client Health Behavior, we analyzed the relationship between maternal education level and a mother's receipt of HIV testing via multinomial logistic regression. Eleven percent of the sample population did not receive a prenatal HIV test, and thirty-six percent of the sample did not report their HIV testing status. Regression results indicate that race, marital status, and primary source of insurance - not education level - are significant predictors of receipt of prenatal HIV testing. Additionally, white women may be more likely to refuse testing due to low self-perceived risk for HIV transmission. By understanding the relationship between maternal education level and a mother's decision on HIV testing during pregnancy, we may identify potential interventions to help achieve universal HIV screening in pregnant women.

Table of Contents

Table of Contents

Introduction................................................................................................................................... 1

Literature Review.......................................................................................................................... 2

HIV/AIDS in the United States................................................................................................ 2

HIV in Pregnant Women & Associated Issues....................................................................... 3

Screening Policies and Regulations....................................................................................... 5

HIV Screening........................................................................................................................... 7

Testing Barriers......................................................................................................................... 8

The Role of Demographics and Education.............................................................................. 9

Interactive Model of Client Health Behavior...................................................................... 11

Summary.................................................................................................................................. 12

Methodology................................................................................................................................ 13

Research Questions................................................................................................................ 13

Data Source.............................................................................................................................. 13

Conceptual Framework.......................................................................................................... 14

Dependent Variable................................................................................................................ 18

Independent Variable............................................................................................................. 19

Covariates................................................................................................................................ 19

Statistical Analysis................................................................................................................. 22

Results.......................................................................................................................................... 24

Descriptive Statistics - Overall Sample............................................................................... 24

Descriptive Statistics - Sub-question Sample...................................................................... 27

Analysis - Main Question...................................................................................................... 29

Analysis - Sub-question......................................................................................................... 32

Discussion.................................................................................................................................... 36

Limitations............................................................................................................................... 43

Future Research...................................................................................................................... 45

Conclusion................................................................................................................................... 47

References.................................................................................................................................... 48

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Health Services Research HIV Screening Maternal Education
Committee Chair / Thesis Advisor	Blake, Sarah, Emory University
Committee Members	Gaydos, Laurie, Emory University Hagen, Kimbi, Emory University Adams, Kathleen, Emory University
Partnering Agencies	Georgia state or local health department

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