Discussing Childbearing with HIV-infected Women of Reproductive Age in Clinical Care: A Comparison of Brazil and the US

Abstract

Despite long term access to highly active antiretroviral therapy in Brazil and the US, little is known about women's communication with their HIV provider regarding childbearing or the unmet need for reproductive counseling. We utilized identical survey questions to collect data from HIV-infected women of reproductive age in Rio de Janeiro (n = 180) and Baltimore (n = 181). We conducted univariate analyses to compare findings between samples of women and multivariate logistic regression to determine factors associated with childbearing desires, childbearing intentions, and provider communication among the combined sample of women (n = 361). Over one-third of women in Rio de Janeiro and nearly one-half of women in Baltimore reported the desire for future childbearing. Nevertheless, the majority of women in clinical care had not discussed future childbearing with their HIV provider. Even in countries with an advanced approach to HIV care, we found low and inadequate communication between providers and female patients about childbearing.

Rates and predictors of prenatal depression in women living with and without HIV

“…Because fertility desires are not impacted by HIV serostatus (Chen, Phillips, Kanouse, Collins, & Miu, 2001;Finocchario-Kessler et al, 2012;Loutfy et al, 2009), a growing number of women face pregnancy complicated by HIV infection, and will confront the concomitant demands of these two conditions. Moreover, prenatal depression affects women's physical and mental well-being in multiple ways, making it important to investigate the impact of prenatal depression, especially among women with HIV (Psaros, Geller, & Aaron, 2009).…”

HIV+ Men Need Reproductive Counseling Too: Assessing Childbearing Goals and Provider Communication Among HIV+ Male Patients in Rio de Janeiro, Brazil

“…This analysis focused on the 311 heterosexual and bisexual HIV + men who completed questions related to future childbearing plans included in the larger survey assessing a multitude of topics relevant to people living with HIV. Childbearing related data from the 180 HIV + female participants of reproductive age have been published, 13 and such items were skipped for the 409 homosexual male participants.…”

“…[4][5][6] Recognizing the importance of having children among HIV + men, patients need to be able to discuss and plan such childbearing decision making with their HIV provider and partner. There is growing awareness of the unmet need for reproductive counseling among HIV + women in clinical care, as illustrated by recent studies in Brazil, 12,13 the United States, [14][15][16][17] and sub-Saharan Africa. 18,19 This same need for reproductive counseling among HIV + male patients has been largely ignored.…”

Perspectives on safer conception practices and preconception counseling among women living with HIV

“…Acquisition of HIV neither reduces the desire to have children nor the likelihood of having children (e.g., Ethiopia: Melaku, Zeleke, Kinsman & Abraha, 2014; USA: Finocchario-Kessler et al, 2010, 2012; Rahangdale et al, 2014; Sutton et al, 2014; Zimbabawe: Clouse et al, 2014). Women of reproductive age (15–45 years) constitute a significant portion of newly and previously diagnosed cases of HIV, and as such, the number of children born to HIV-infected mothers continue to rise globally (Ethiopia: Melaku et al, 2014; USA: CDC, 2013; Hoyt et al, 2012; Rahangdale et al, 2014; Steiner, Finocchario-Kessler, & Dariotis, 2013; Sutton et al, 2014; Zimbabwe: Clouse et al, 2014).…”

“…Women of reproductive age (15–45 years) constitute a significant portion of newly and previously diagnosed cases of HIV, and as such, the number of children born to HIV-infected mothers continue to rise globally (Ethiopia: Melaku et al, 2014; USA: CDC, 2013; Hoyt et al, 2012; Rahangdale et al, 2014; Steiner, Finocchario-Kessler, & Dariotis, 2013; Sutton et al, 2014; Zimbabwe: Clouse et al, 2014). Prevention of Mother to Child Transmission (PMTCT) strategies, e.g., adherence to prescribed antiretroviral therapy and post-partum regimens, has been associated with less than 1% risk of mother-to-child-transmission of HIV, making pregnancy a viable option for HIV-infected women (e.g., Italy: Marazzi et al, 2011; USA: Finocchario-Kessler et al, 2010, 2012; Hoyt et al 2012; Loutfy et al, 2013; Rahangdale et al, 2014; Zambia: Chibwesha et al, 2011;). Computer modeling estimates indicate that 90–95% participation in PMTCT plus effective antiretroviral therapy (Torpey et al, 2012) would reduce infant HIV incidence to the WHO (2008) goal of < 5% (Ciaranello, Perez, Keatinge, Park, Engelsmann, & Maruva, 2012), drastically decreasing vertical and sexual transmission of the virus (e.g., Italy: Monforte et al, 2014; USA: Hoyt et al, 2012; Sutton et al, 2014; Squires et al, 2011).…”