Decrease of condom use in heterosexual couples and its impact on pregnancy rates: the Swiss HIV Cohort Study (SHCS)

Hachfeld, Anna; Atkinson, Andrew; Calmy, Alexandra; Tejada, Begoña Martínez de; Hasse, Barbara; Paioni, Paolo; Kahlert, Christian; Boillat‐Blanco, Noémie; Stoeckle, Marcel; Aebi‐Popp, Karoline

doi:10.1111/hiv.13152

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…Of the WLWH in Finland, 11% have had an induced abortion after being diagnosed, a proportion similar to some previous studies [ 15 , 25 , 26 ]. Similar to our study, younger age and previous pregnancies have been associated with an increased risk of induced abortion in two previous cohort studies among WLWH in Italy and the US [ 10 , 15 ].…”

Section: Discussionsupporting

confidence: 87%

Induced abortions of women living with HIV in Finland 1987–2019: a national register study

Mutru

Kivelä

Ollgren

et al. 2023

BMC Pregnancy Childbirth

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Background Recent data on the rate and risk factors of induced abortion among women living with HIV (WLWH) are limited. Our aim was to use Finnish national health register data to 1) determine the nationwide rate of induced abortions of WLWH in Finland during 1987–2019, 2) compare the rates of induced abortions before and after HIV diagnosis over different time periods, 3) determine the factors associated with terminating a pregnancy after HIV diagnosis, and 4) estimate the prevalence of undiagnosed HIV at induced abortions to see whether routine testing should be implemented. Methods A retrospective nationwide register study of all WLWH in Finland 1987–2019 (n = 1017). Data from several registers were combined to identify all induced abortions and deliveries of WLWH before and after HIV diagnosis. Factors associated with terminating a pregnancy were assessed with predictive multivariable logistic regression models. The prevalence of undiagnosed HIV at induced abortion was estimated by comparing the induced abortions among WLWH before HIV diagnosis to the number of induced abortions in Finland. Results Rate of induced abortions among WLWH decreased from 42.8 to 14.7 abortions/1000 follow-up years from 1987–1997 to 2009–2019, more prominently in abortions after HIV diagnosis. After 1997 being diagnosed with HIV was not associated with an increased risk of terminating a pregnancy. Factors associated with induced abortion in pregnancies that began after HIV diagnosis 1998–2019 were being foreign-born (OR 3.09, 95% CI 1.55–6.19), younger age (OR 0.95 per year, 95% CI 0.90–1.00), previous induced abortions (OR 3.36, 95% CI 1.80–6.28), and previous deliveries (OR 2.13, 95% CI 1.08–4.21). Estimated prevalence of undiagnosed HIV at induced abortion was 0.008–0.029%. Conclusions Rate of induced abortions among WLWH has decreased. Family planning should be discussed at every follow-up appointment. Routine testing of HIV at all induced abortions is not cost-effective in Finland due to low prevalence.

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Section: Discussionsupporting

confidence: 87%

Induced abortions of women living with HIV in Finland 1987–2019: a national register study

Mutru

Kivelä

Ollgren

et al. 2023

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…4,11,12 Moreover, this trend is observed in both resource-constrained as well as in resource-abundant settings, highlighting a potential unmet need for family planning services globally. [13][14][15][16] Clinicians who provide family planning care for people capable of pregnancy should be equipped to provide contraception and abortion care to people living with HIV. This review serves as a resource for reproductive health care practitioners faced with clinical scenarios at the intersection of HIV and family planning.…”

Section: Unmet Need For Abortion and Contraception Accessmentioning

confidence: 99%

“…In the United States, the rate of long‐acting reversible contraception use among women living with HIV is lower compared with women without HIV 4,11,12 . Moreover, this trend is observed in both resource‐constrained as well as in resource‐abundant settings, highlighting a potential unmet need for family planning services globally 13–16 . Clinicians who provide family planning care for people capable of pregnancy should be equipped to provide contraception and abortion care to people living with HIV.…”

Section: Introductionmentioning

confidence: 99%

Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners

Yang,

Allen,

Cambou

et al. 2023

J Midwife Womens Health

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People capable of pregnancy are disproportionately affected by HIV. Family planning needs and services are often unmet in this population, and clinical care guidelines regarding contraceptive options and abortion care are not well elucidated. Individuals living with HIV often face unique barriers in accessing contraception and abortion services due to internalized stigma, medically complex care (eg, drug–drug interactions, adverse effects of antiretroviral therapy), and distrust of health care providers. There is also a lack of clarity among reproductive health, primary, and infectious disease care providers on best‐practice contraceptive counseling and contraceptive care for individuals living with HIV, given limited opportunities to enhance expertise in reproductive infectious disease. In this review, we summarize existing and updated evidence and clinical considerations regarding contraceptive counseling and abortion care in this population.

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Incidence of Childbirth, Pregnancy, Spontaneous Abortion, and Induced Abortion Among Women With Human Immunodeficiency Virus in a Nationwide Matched Cohort Study

Paulsen

Tetens

Vollmond

et al. 2023

Clinical Infectious Diseases

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Background Reproductive health in women with HIV (WWH) has improved in recent decades. We aimed to investigate incidences of childbirth, pregnancy, spontaneous abortion, and induced abortion among WWH in a nationwide, population-based, matched cohort study. Methods We included all WWH aged 20 to 40 treated at an HIV healthcare centre in Denmark from 1995-2021, and a matched comparison cohort of women from the general population (WGP). We calculated incidence rates per 1,000 person years and used Poisson regression to calculate adjusted incidence rate ratios (aIRR) of childbirth, pregnancy, spontaneous abortion, and induced abortion stratified according to calendar periods (1995-2001, 2002-2008, and 2009-2021). Results We included 1,288 WWH and 12,880 WGP. 46% of WWH were of African origin whereas 1% of WGP were of African origin. Compared to WGP, WWH had a decreased incidence of childbirth (aIRR: 0.6, 95% CI: 0.6-0.7), no difference in incidence of pregnancy (aIRR: 0.9, 95% CI: 0.8-1.0) or spontaneous abortion (aIRR: 0.9, 95% CI: 0.8-1.0), but an increased incidence of induced abortion (aIRR: 1.9, 95% CI: 1.6-2.1) from 1995-2021. The aIRR of childbirth, pregnancy, and spontaneous abortion increased from 1995-2000 to 2009-2021, while the aIRR of induced abortion remained increased across all time-periods for WWH. Conclusion From 1995-2008, incidences of childbirth, pregnancy, and spontaneous abortion were decreased among WWH compared to WGP. From 2009-2021, the incidence of childbirth, pregnancy, and spontaneous abortion no longer differed among WWH compared with WGP. The incidence of induced abortions remains increased among WWH.

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Decrease of condom use in heterosexual couples and its impact on pregnancy rates: the Swiss HIV Cohort Study (SHCS)

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 4 publications

References 36 publications

Induced abortions of women living with HIV in Finland 1987–2019: a national register study

Induced abortions of women living with HIV in Finland 1987–2019: a national register study

Contraception and Abortion Care for People Living With HIV: A Clinical Guide for Reproductive Health Practitioners

Incidence of Childbirth, Pregnancy, Spontaneous Abortion, and Induced Abortion Among Women With Human Immunodeficiency Virus in a Nationwide Matched Cohort Study

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