For monitoring the spread of HIV epidemic, both national population-based surveys and antenatal clinics (ANC) are used. However, in all cases, there are potential biases. Bias associated with ANC data includes whether the pregnant women who attend public ANC are representative of all pregnant women. Reduced fertility among HIV-infected women, selection for sexual activity and under-representation of smaller rural sites in surveillance systems are other factors that may be source of biases (Boerma et al. 2003 & Walker et al. 2003). So, the question arising is how women who attend ANC could be representative of the general female population. Evidently, not all women become pregnant and not all pregnant women attend ANC. This research project has been designed to address those biases especially in Rwanda and Malawi. It focused on investigating the significance of this bias by doing a comparative analysis of sero prevalence between both those using ANC and those who do not. This study, therefore, intends to test whether women attending ANC may be representative to the general female population of both Rwanda and Malawi using respectively 2004 MDHS and 2005 RDHS. Using statistical techniques with the aid of STATA software program, univariate, bivariate and logistic regression (bivariate and multivariate) were performed for 11321 women in Rwanda and 11698 in Malawi aged between 15 and 49. However, among them, those who had live birth in last five years prior to the surveys were the most interested on in this study; that is especially, 5390 in Rwanda and 7304 in Malawi. Besides, HIV status of respondents was an important variable. Considering both women who had live birth and those who did not have live birth, I find that women who had live birth in Rwanda are 0.62 times less likely to be HIV positive and 0.48 times less likely to be infected for those who had live birth in Malawi. When controlling for women who had live birth, I find that in both countries women who use ANC are less likely to be infected compared to those who do not (0.53 times less likely in Rwanda and 0.58 times less likely in Malawi). Based on these findings, relying only on data from ANC may lead to biases in HIV prevalence estimates; particularly referring to 2004 MDHS and 2005RDHS. Besides, considering the level of significance of the difference between HIV status between those who use ANC and those who do not, I find that this is not identical in Rwanda (5% level of significance) and in Malawi (10% level of significance). Thus, these results suggest, briefly, that not only the degree of ANC data representativeness is changing depending on various stages of HIV epidemic as Fylkesnes said (1998), but also is affected by the amount of women who had live birth and their respective HIV status. In fact, this difference may be based on the fact that in Malawi, HIV prevalence is high compared to Rwanda and those who had live birth were in high percentage comparing to Rwanda.

MSc (Med) Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Research Project Title: HIV Prevalence and Factors Associated with HIV Infection in South Africa: Analysis of the Antenatal Clinic Survey Data. Background: In sub-Saharan Africa, the HIV epidemic is commonly monitored through the sentinel surveillance of pregnant women attending antenatal clinics (ANC), which provides important indications for planning and evaluating public-health interventions. Many of such surveillance systems in South Africa reported limited information on factors associated with HIV infection, even though the survey collected information related to a woman’s participation. This is likely to compromise the development of effective preventive programmes that are more focussed. To address this, the 2005 HIV (ANC) surveillance data was used with the objective of increasing the available information on the HIV epidemic in the country and identifying the socio-demographic factors associated with HIV infection in each province. Methodology: The data from the 2005 ANC survey was analysed in depth. The chi-square test was used to test bivariate associations for categorical associations of HIV infection and other associated factors. In addition a logistic regression model was used to explore the association of sociodemographic and other variables with HIV infection in each province. Results: The HIV prevalence reported in this study was similar to earlier reports released by the Department of Health in 2005. That is the overall HIV prevalence is 30.1% (29.5-30.8%) with KwaZulu Natal having the highest (39.1%, 37.5-40.1%) and Western Cape recorded the lowest HIV prevalence of 15.9% (14.1-17.4%).

Background: The prevalence of cases of HIV among children below the ages of 15 years continues to increase and majority of these children acquired the infection through mother-to-child transmission. Methodology: The main objectives of the study were to explore the perceptions of local women regarding the PMTCT program, to evaluate the strength of these perceptions and to make recommendations. A qualitative method was used involving a number of focus group discussions among antenatal clinic attendees in the 27 primary health care clinics in Qwa-Qwa, Free State province of South Africa. Findings: The findings were organised under eight major themes: (1) Knowledge of the program -where the participants expressed high knowledge about the PMTCT program as they knew how MTCT of HIV occurs and how it can be prevented, (2) Perceived concerns about the program- which were mainly fear of resistance to ARVs, fear of stopping the treatment after delivery, potential for high numbers of orphans, depression and suicide when HIV result is positive, the fear of the family neglecting the baby if the mothers dies, the perception that the program cares for only the babies and not their mother, (3)Readiness to do HIV test- where majority of the participants said it was difficult doing the HIV test due to fear of positive result, (4) Ease of taking ARVs- Difficulty in taking the ARVs due to fear of resistance and harmful side effects, (5) Relationship with clinic staff- a majority of the participants were happy with their relationship with the clinic staff, (6) Reactions expected from family members when program advice is followed- more than half of the participants expected negative reactions from family members if the program advice is followed because of the negative attitudes of their male partners and the elders’ of the resistance to change from their cultural beliefs, (7) Advantages of the program- according to the focus group participants, the advantages of the program include the knowledge gained about HIV, modes of MTCT of HIV and how to prevent MTCT of HIV. Other advantages mentioned were prevention of MTCT of HIV, pre-test counselling reducing the fear of doing HIV test, knowing one’s HIV status as well as the potential of the program to have positive change on the cultural beliefs of the people, and lastly (8)How they felt being part of the program- where all the participants said they were excited . Conclusions: The findings were similar to those of other studies in many respects. Recommendations: The recommendations were community and family HIV/AIDS education and their involvement in the PMTCT program in other to reduce misconceptions about the disease, and stigmatization against the women in the program. Other recommendations include: the concept of PMTCT-plus which provides ongoing support and treatment for the mothers, babies and infected family members; integration of innovative health education and culturally appropriate interventions into the program; provision of adequate maternity leaves to women in the PMTCT program as well as full integration of the PMTCT program into the District Health System (DHS) as part of the “horizontal” delivered package.