Fertility preferences, condom use, and concerns among HIV‐positive women in serodiscordant relationships in the era of antiretroviral therapy

Ezeanochie, Michael; Olagbuji, Biodun Nelson; Ande, Adedapo; Oboro, VO

doi:10.1016/j.ijgo.2009.06.013

Cited by 15 publications

(11 citation statements)

References 7 publications

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“…Reduced pregnancy rates among women with more sexual partners may be the result of these women engaging in sex differently than women with fewer partners, in a way that is not discernable from the data. For example, the definition of “sex” on the WIHS questionnaire includes oral, vaginal and anal sex, while only unprotected vaginal sex is a risk factor for pregnancy [9]. Lack of data describing frequency of sexual intercourse prevents further exploration of this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Relative time to pregnancy among HIV-infected and uninfected women in the Women's Interagency HIV Study, 2002–2009

Linas

Minkoff

Cohen

et al. 2011

Aids

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Objectives To determine the incidence rate of, and the relative time to pregnancy by HIV status in US women between 2002 and 2009. Design The Women’s Interagency HIV Study (WIHS) is an ongoing, multicenter prospective cohort study of the natural and treated history of HIV infection and related outcomes among women with and without HIV. Methods Eligible participants were ≤45 years of age; sexually active with male partner(s) or reported a pregnancy outcome within the past year; and never reported hysterectomy, tubal ligation, or oopherectomy. Poisson regression was conducted to compare pregnancy incidence rates over time by HIV status. Relative time to pregnancy was ascertained via Kaplan-Meier plots and generalized gamma survival analysis. Results Adjusting for age, number of male sex partners, contraception, parity, exchanging sex, and alcohol use, HIV infection was associated with a 40% reduction in the incidence rate of pregnancy (incidence rate ratio=0.60, 95% confidence interval: [C.I.] 0.46–0.78). The time for HIV-infected women to become pregnant was 73% longer relative to HIV-uninfected women (relative time=1.73, 95% C.I.: 1.35–2.36). In addition to HIV infection, decreased parity and older age were independent predictors of lower pregnancy incidence. Conclusions Despite the beneficial effects of modern antiretroviral therapy on survival and prevention of maternal-to-child transmission, our findings suggest that pregnancy incidence remains lower among HIV-infected women. Whether this lower incidence is due to behavioral differences or reduced biologic fertility remains an area worthy of further study.

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Section: Discussionmentioning

confidence: 99%

Relative time to pregnancy among HIV-infected and uninfected women in the Women's Interagency HIV Study, 2002–2009

Linas

Minkoff

Cohen

et al. 2011

Aids

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“…Infertility problems were confi rmed in a Spanish study [36] with abnormal semen parameters in 83.4% of HIV-infected and 41.7% of HIV-uninfected partners of 130 HIV-positive women. In an African study, there was a high level of risk exposure for non-infected male partners of HIV-positive women desiring pregnancy [37].…”

Section: Fatherhood and Conceptionmentioning

confidence: 99%

Fathers and HIV: considerations for families

Sherr

2010

Journal of the International AIDS Society

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BackgroundFathers are intricately bound up in all aspects of family life. This review examines fathers in the presence of HIV: from desire for a child, through conception issues, to a summary of the knowledge base on fathers within families affected by HIV.MethodsA mixed-methods approach is used, given the scarcity of literature. A review is provided on paternal and male factors in relation to the desire for a child, HIV testing in pregnancy, fatherhood and conception, fatherhood and drug use, paternal support and disengagement, fatherhood and men who have sex with men (MSM), and paternal effects on child development in the presence of HIV. Literature-based reviews and systematic review techniques are used to access available data Primary data are reported on the issue of parenting for men who have sex with men.ResultsMen with HIV desire fatherhood. This is established in studies from numerous countries, although fatherhood desires may be lower for HIV-positive men than HIV-negative men. Couples do not always agree, and in some studies, male desires for a child are greater than those of their female partners. Despite reduced fertility, support and services, many proceed to parenting, whether in seroconcordant or serodiscordant relationships. There is growing knowledge about fertility options to reduce transmission risk to uninfected partners and to offspring.Within the HIV field, there is limited research on fathering and fatherhood desires in a number of difficult-to-reach groups. There are, however, specific considerations for men who have sex with men and those affected by drug use. Conception in the presence of HIV needs to be managed and informed to reduce the risk of infection to partners and children. Further, paternal support plays a role in maternal management.ConclusionsStrategies to improve HIV testing of fathers are needed. Paternal death has a negative impact on child development and paternal survival is protective. It is important to understand fathers and fathering and to approach childbirth from a family perspective.

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“…CD4+ count is also known to have inverse relationship with viral load which has been shown as the most powerful predictor for HIV transmission to an uninfected partner. 19 However, one of the limitations of this study was inability to assess the viral load of the participants. Again, the power of this finding is weakened by the cross-sectional nature of the study as the CD4+ count at booking may not represent the count at the time of infection of the partner, all things being equal.…”

Section: Discussionmentioning

confidence: 91%

The prevalence and determinants of female serodiscordance among HIV positive pregnant women attending PMTCT clinic in Owerri, Imo state, Nigeria

Eze

Okeudo

Ezem

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: Human Immunodeficiency Virus sero-discordance is high among heterosexual couples in Africa. However, only few studies have explored the factors that are associated with the prevalence in sub-Saharan Africa. The aim of this study was to determine the prevalence of female sero-discordance among HIV positive pregnant women in Owerri and to assess its possible associated factors.Methods: A cross sectional study of pregnant women (and their partners) who tested positive to HIV I and II at the Prevention of Mother to Child Transmission (PMTCT) clinic from December 2015 to May 2016 in Federal Medical Center Owerri, Imo state, Nigeria.Results: A total of 106 HIV positive pregnant women (and their partners) were studied. The prevalence of female serodiscordance was 63.2% (67/106). Pre-marital serodiscordance contributed about 52.2% (35/67) female serodiscordance among couples in the study. Sero-discordance rate for the lower, middle, and upper classes were 50% (28/56), 76.1% (35/46) and 100% (4/4) respectively and was statistically significant (p<0.01). Condom use was significantly associated with female serodiscondance (P<0.01). CD4+ count of the female partner at booking was also found statistically significantly associated with female serodiscordance (P<0.01).Conclusions: There is high prevalence of female serodiscordance among HIV positive pregnant women in Owerri. Pre-marital serodiscordance contributed significantly to high level of female serodiscordance among couples. Higher social class, condom use and high female- partner CD4+ count are significantly associated with female sero-discordance.

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Fertility preferences, condom use, and concerns among HIV‐positive women in serodiscordant relationships in the era of antiretroviral therapy

Abstract: With improving immunologic and clinical status once antiretroviral therapy is initiated, HIV-positive women wishing to become pregnant may engage in risky sexual practices. This trend needs to be addressed because of its consequences for public health.

Cited by 15 publications

References 7 publications

Relative time to pregnancy among HIV-infected and uninfected women in the Women's Interagency HIV Study, 2002–2009

Relative time to pregnancy among HIV-infected and uninfected women in the Women's Interagency HIV Study, 2002–2009

Fathers and HIV: considerations for families

The prevalence and determinants of female serodiscordance among HIV positive pregnant women attending PMTCT clinic in Owerri, Imo state, Nigeria

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