Contraception and fertility plans in a cohort of HIV-positive women in care

Abstract

Objective: To examine determinants of contraceptive use, desired future childbearing, and sterilization regret among HIV-positive women.Methods: 118 HIV-positive women, age 18-46, receiving care at a University HIV Clinic completed a survey on their reproductive history in 2004. We reviewed their medical records for contraception, antiretroviral medications and HIV/AIDS disease markers. We performed descriptive analysis of population characteristics and logistic regression to assess predictors of their desire to have future children.Results: Subjects had a median age of 37, had been diagnosed with HIV for a mean of 9.2 years and 55% had AIDS. Most (68%) subjects were currently monogamous and 29% were abstinent. Forty-seven percent had been sterilized and of those who were sexually active but not sterilized, 90% were using reversible contraception. One-third of subjects desired future childbearing, including 12% of those who had been previously sterilized. In a multivariate analysis, predictors of desire for future childbearing were: younger age, not being on HIV medication, higher current CD4 cell count and having a relationship duration of less than 2 years. Conclusion:HIV-positive women have reproductive patterns similar to HIV-negative women, with most having borne children and many wanting children in the future. A substantial proportion has been sterilized and express sterilization regret. Potent antiretroviral therapy has greatly improved the outlook for HIV-infected women, even those with an AIDS diagnosis. Many HIV-positive women want to have children and would benefit from preconception counseling and counseling about reversible methods of contraception.

Childbearing Intentions of HIV-Positive Women of Reproductive Age in Soweto, South Africa: The Influence of Expanding Access to HAART in an HIV Hyperendemic Setting

“…7 A recent American study showed that HAART use was associated with a lower prevalence of fertility desires. 39 Our findings are, however, consistent with those of a recent Canadian study that reported no association between HAART use and childbearing intentions. 40 Potential reasons for our findings may relate to the nature of HAART and HIV care services at the PHRU.…”

“…26,40 Consistent with other studies of HIV-positive and HIV-negative women around the world, number of living children and current partnership status were also strongly associated with childbearing intentions. 6,7,39,40,43 Although HAART use did not affect childbearing intentions among HIV-positive women, we did find that HIV-positive women were 60% less likely than were HIV-negative women to report an intention to have (more) children. It is difficult to compare these findings to other settings since we could identify no studies that directly measured differences in childbearing intentions between HIV-negative and HIV-positive women.…”

Fertility intentions of HIV-infected women in the United Kingdom

“…Some studies subsequently showed an increase in pregnancy incidence among HIV-infected women (Blair et al, 2004;, and a corresponding decline in terminations (Massad et al, 2004;Townsend et al, 2008). Recent studies in resource-rich settings suggest that around a quarter to a third of HIV-infected women of reproductive age intend to have children in the future, with rates approaching those in the general population (Ogilvie et al, 2007;Myer et al, 2007;Stanwood et al, 2007;Heard et al, 2007). Furthermore some studies in Africa have shown an association between use of HAART and increased fertility intentions (Maier et al, 2009;Cooper et al, 2009).…”

Fertility desires of women living with HIV/aids in northern British Columbia.

“…Without treatment, 30% of infants bom to HIV-infected women will become infected during pregnancy, in labour and delivery, or through breastfeeding (UNAIDS, 2008;Info report, 2006). Thus, in view of the UNAIDS Half of the over 40 million people living with HIV/AIDS worldwide are women (Stanwood, Cohn, Heiser, & Pugliese, 2007); the same is true in Canada (HIV/AIDS Epi update, 2010). In Canada, more than 23% of new HIV infections occur in women and 80% of these women are in their childbearing age (Public Health Agency o f Canada 2010; Ogilvie et al, 2007).…”

“…Young women acquiring HIV through heterosexual contact are the new wave of the epidemic (Stanwood, Cohn, Heiser, & Pugliese, 2007). The advent of HARRT provided the HIV-positive women new opportunities, such as the possibility of parenthood and increased life expectancy (Wagner et al, 2010).…”