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Tufa D, Wassihun B, Misker D, Beyene K. Fertility desire and associated factors among women of reproductive age living with HIV/AIDS attending antiretroviral therapy clinic in Arba Minch General Hospital, South Ethiopia, 2021. Front Glob Womens Health 2023; 4:1001479. [PMID: 38025980 PMCID: PMC10666766 DOI: 10.3389/fgwh.2023.1001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background The fertility desire of women living with HIV to have children can have significant implications for public health. Despite the increase in the number of HIV-positive women, the issues of their fertility desire have not been well-studied. This study aims to assess fertility desire and associated factors among women living with HIV/AIDS. Methods A facility-based cross-sectional study was conducted from 1 May to 30 July 2021. The researchers employed a systematic sampling technique. The data were gathered and entered into EpiData 3.1 software, and subsequently exported to the statistical package for social science version 25 for analysis. Binary logistic regression analyses were used to identify the factors involved, and a p-value of <0.05 at a 95% confidence level was deemed to be statistically significant. Result The findings of this study indicate that 47.8% of women expressed a desire to conceive. Various factors such as parents' pressure [adjusted odds ratio (AOR) = 4.41, 95% confidence interval (CI): 2.15-9.05], community pressure (AOR = 2.62, 95% CI: 1.30-5.26), being married (AOR = 0.25, 95% CI: 0.09-0.73), having only female offspring (AOR = 2.57, 95% CI: 1.12-5.90), and having HIV seropositive children (AOR = 2.45, 95% CI: 1.23-4.85) had statistically significant association with fertility desire. Conclusion The study area exhibited a high level of fertility desire. Various factors can influence fertility desire, including parents' pressure, community pressure, being married, having only female offspring, and having children who are HIV seropositive. When developing interventions on sexual and reproductive health issues, it is imperative for policymakers and healthcare providers who are working in antiretroviral therapy clinics to take into account the effects of these factors on women living with HIV. When designing and implementing prevention of mother-to-child transmission services, it is important to consider the fertility desires of mothers who are living with HIV.
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Affiliation(s)
- Disasa Tufa
- Gather Hospital, South Omo Zone, Jinka, Ethiopia
| | - Biresaw Wassihun
- Department of Midwifery, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Direslgne Misker
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Kassaw Beyene
- Department of Midwifery, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Chagomerana MB, Harrington BJ, DiPrete BL, Wallie S, Maliwichi M, Wesevich A, Phulusa JN, Kumwenda W, Jumbe A, Hosseinipour MC. Three-year outcomes for women newly initiated on lifelong antiretroviral therapy during pregnancy - Malawi option B. AIDS Res Ther 2023; 20:37. [PMID: 37308909 PMCID: PMC10258937 DOI: 10.1186/s12981-023-00523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 05/02/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Antiretroviral therapy (ART) is very effective in preventing vertical transmission of HIV but some women on ART experience different virologic, immunologic, and safety profiles. While most pregnant women are closely monitored for short-term effects of ART during pregnancy, few women receive similar attention beyond pregnancy. We aimed to assess retention in care and clinical and laboratory-confirmed outcomes over 3 years after starting ART under Malawi's Option B + program. METHODS We conducted a prospective cohort study of pregnant women newly diagnosed with HIV who started tenofovir disoproxil fumarate/emtricitabine/efavirenz (TDF/3TC/EFV) for the first time at Bwaila Hospital in Lilongwe, Malawi between May 2015 and June 2016. Participants were followed for 3 years. We summarized demographic characteristics, pregnancy outcomes, and clinical and laboratory adverse events findings using proportions. Log-binomial regression models were used to estimate the overall risk ratios (RR) and the corresponding 95% confidence interval (CI) for the association between index pregnancy (i.e. index pregnancy vs. subsequent pregnancy) and preterm birth, and index pregnancy and low birthweight. RESULTS Of the 299 pregnant women who were enrolled in the study, 255 (85.3%) were retained in care. There were 340 total pregnancies with known outcomes during the 36-month study period, 280 index pregnancies, and 60 subsequent pregnancies. The risks of delivering preterm (9.5% for index pregnancy and13.5% for subsequent pregnancy: RR = 0.70; 95% CI: 0.32-1.54), or low birth weight infant (9.8% for index pregnancy and 4.2% for subsequent pregnancy: RR = 2.36; 95% CI: 0.58-9.66) were similar between index and subsequent pregnancies. Perinatally acquired HIV was diagnosed in 6 (2.3%) infants from index pregnancies and none from subsequent pregnancies. A total of 50 (16.7%) women had at least one new clinical adverse event and 109 (36.5%) women had at least one incident abnormal laboratory finding. Twenty-two (7.3%) women switched to second line ART: of these 64.7% (8/17) had suppressed viral load and 54.9% (6/17) had undetectable viral load at 36 months. CONCLUSION Most of the women who started TDF/3TC/EFV were retained in care and few infants were diagnosed with perinatally acquired HIV. Despite switching, women who switched to second line therapy continued to have higher viral loads suggesting that additional factors beyond TDF/3TC/EFV failure may have contributed to the switch. Ongoing support during the postpartum period is necessary to ensure retention in care and prevention of vertical transmission.
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Affiliation(s)
- Maganizo B Chagomerana
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi.
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bryna J Harrington
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
- Johns Hopkins Dept. of Gynecology & Obstetrics, Baltimore, MD, USA
| | - Bethany L DiPrete
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Austin Wesevich
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | | | - Wiza Kumwenda
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Allan Jumbe
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Mina C Hosseinipour
- UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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A Systematic Mixed Studies Review of the Intersections of Social-Ecological Factors and HIV Stigma in People Living With HIV in the U.S. South. J Assoc Nurses AIDS Care 2020; 30:330-343. [PMID: 31021963 DOI: 10.1097/jnc.0000000000000076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The role of stigma on psychological wellness and treatment outcomes in people living with HIV (PLWH) has been well documented. However, within the context of the southern United States, the intersection between HIV-related stigma and social-ecological factors has been understudied. Thus, a results-based convergent, mixed synthesis design was used to examine the manifestations of HIV-related stigma in PLWH in the U.S. South. A literature search was conducted using PsycINFO, PubMed (includes MEDLINE), and CINAHL. The first level of screening by title and abstract was administered on 1,829 articles. A full-text screening of 169 studies was completed, and a total of 30 relevant articles were extracted. The mixed synthesis highlighted intervention strategies that can reduce HIV-related stigma while promoting positive health-behavior change. The findings of this review underscored the uniqueness of PLWH in the south and demonstrated the crucial role of intersectionality in investigating HIV-related stigma in treating and preventing HIV.
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Pregnancy Incidence and Fertility Desires Among Couples by HIV Status in Rakai, Uganda. J Acquir Immune Defic Syndr 2019; 80:494-502. [PMID: 30664614 DOI: 10.1097/qai.0000000000001951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The desire for more children and pregnancy rates are influenced by many relationship dynamics and HIV serostatus of couples. SETTING Rakai Community Cohort Study in Uganda. METHODS Couple data were retrospectively linked from survey rounds between 2007 and 2015 to assess drivers of fertility desire and pregnancy incidence by HIV status (M-F-; M+F+; M-F+; and M+F-). Multivariable modified Poisson regression was used to estimate prevalence ratios of fertility desire, whereas multivariable Poisson regression was used to estimate incidence rate ratios of pregnancy associated with couple characteristics. RESULTS Six thousand six hundred forty-seven couples contributed to 7656 person-years. Approximately 40% of couples (where at least 1 HIV+) desired more children. Unmet need for family planning was evident; couples of medium or low Socioeconomic status and with coresident children had lower fertility desires but higher pregnancy rates. Older age, being in a polygamous union, and having a HIV+ spouse in care were associated with lower fertility desire while having an older male partner was associated with higher fertility desire. Pregnancy incidence was lower with older age, among women using hormonal contraception and condoms, HIV+ concordant couples and couples where the HIV+ spouse was in care while pregnancy incidence were higher among women who desired more children, and serodiscordant couples (M-F+). CONCLUSIONS There are many drivers of fertility desires and pregnancy rates, and HIV does not diminish the desire for more children. Unmet need for family planning was evident and highlighted the need to understand and meet the contraceptive needs of couples.
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Arora KS, Wilkinson B. Eliminating Perinatal HIV Transmission in the United States: The Impact of Stigma. Matern Child Health J 2018; 21:393-397. [PMID: 28032237 DOI: 10.1007/s10995-016-2204-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, USA.
| | - Barbara Wilkinson
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, USA
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Leyva-Moral JM, Palmieri PA, Feijoo-Cid M, Cesario SK, Membrillo-Pillpe NJ, Piscoya-Angeles PN, Goff M, Toledo-Chavarri A, Edwards JE. Reproductive decision-making in women living with human immunodeficiency virus: A systematic review. Int J Nurs Stud 2017; 77:207-221. [PMID: 29112908 DOI: 10.1016/j.ijnurstu.2017.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Analyze and synthesize the research evidence to understand the reproductive decisions made by women living with HIV from the beginning of the epidemic to the present. Evaluate the barriers and the facilitators for reproductive decision-making. Identify areas of strength, improvement, and those requiring further research. DESIGN AND DATA SOURCES Systematic review following the PRISMA guideline. PubMed, CINAHL, PsycINFO, Cochrane Library, SocINDEX, Embase, and Scopus databases were searched from 1985 to 2016 using the following Keywords: HIV, AIDS, pregnancy, reproduction, and decision-making. STUDY SELECTION A total of 42 research papers were included in this review. Initially, 1563 papers were identified for the review by database (n=1544) and hand (n=19) searches. With three review levels, 1521 papers were excluded (title review, n=1272; abstract review, n=136; and full paper review, n=113). Studies published in English in peer-reviewed journals using both quantitative and qualitative methods and addressing reproductive decisions in women living with HIV were included. Thirdly, inclusion eligibility was assessed by title, abstract, and full text. REVIEW METHODS Random allocation conducted by the primary researcher assigned an equal number of papers to each researcher for review, including detailed instructions with an abstraction form. Discrepancies were resolved by two researchers. Research quality was assessed using the NCHBL Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, the Critical Appraisal Skills Programme for the qualitative studies and its version for systematic reviews RESULTS: The review included 42 papers, both quantitative (n=24) and qualitative methods (n=14). Most studies were completed by physicians (n=16) or nurses (n=15). More than two-thirds of the studies were performed in urban settings with predominantly African-American women (n=27). Eight factors were identified as influencing the reproductive decision-making process in women living with HIV: 'Socio-demographic, Health status and Pregnancy', 'Religion and spirituality', 'Beliefs and Attitudes about Antiretroviral Therapy', 'Healthcare providers', 'Significant others', 'Motherhood and fulfillment', 'Fear of perinatal infection and infection of partner(s)', 'Birth control and pregnancy management'. CONCLUSIONS Health care providers are not providing patient-centered care by applying scientific evidence to their practice when advising women with HIV in making reproductive decisions. Despite the strong evidence indicating pregnancy for women with HIV results in a safe birthing trajectory, one not likely to jeopardize the health of the either the mother or fetus, providers continue to recommend the women with HIV avoid pregnancy and neglect to invite partners to participate in the discussion.
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Affiliation(s)
- Juan M Leyva-Moral
- Universidad Autónoma de Barcelona, Department of Nursing. Faculty of Medicine. Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - Patrick A Palmieri
- Facultad de Ciencias de la Salud, Universidad Privada Norbert Wiener. Jr. Larrabure y Unanue 110 Urb. Santa Beatriz, Lima, Perú; College of Graduate Health Studies, A.T. Still University (Mesa, Arizona, USA).
| | - María Feijoo-Cid
- Universidad Autónoma de Barcelona, Department of Nursing. Faculty of Medicine. Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - Sandra K Cesario
- College of Nursing, Texas Woman's University, 6700 Fannin St., Houston, TX 77030, United States.
| | | | | | - Marilyn Goff
- Texas Woman's University (Houston Campus). 6700 Fannin St., Houston, TX 77030, United States.
| | - Ana Toledo-Chavarri
- Canary Islands Foundation of Health Research and the Center for Biomedical Research of the Canary Islands. Facultad de Medicina - Universidad de La Laguna San Cristobal de La Laguna, Santa Cruz de Tenerife 38071, España.
| | - Joan E Edwards
- College of Nursing, Texas Woman's University, 6700 Fannin St., Houston, TX 77030, United States.
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Jones DL, Cook R, Potter JE, Miron-Shatz T, Chakhtoura N, Spence A, Byrne MM. Fertility Desires among Women Living with HIV. PLoS One 2016; 11:e0160190. [PMID: 27610626 PMCID: PMC5017599 DOI: 10.1371/journal.pone.0160190] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/14/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Rates of pregnancy among women living with HIV (WLHIV) have increased with the availability of effective HIV treatment. Planning for pregnancy and childbirth is an increasingly important element of HIV care. Though rates of unintended pregnancies are high among women in general, among couples affected by HIV, significant planning and reproductive decisions must be considered to prevent negative health consequences for WLHIV and their neonates. To gain insight into this reproductive decision-making process among WLHIV, this study explored women's knowledge, attitudes and practices regarding fertility planning, reproductive desires, and safer conception practices. It was hypothesized that pregnancy desires would be influenced by partners, families, the potential risk of HIV transmission to infants, and physicians' recommendations. METHODS WLHIV of childbearing age were recruited from urban South Florida, and completed an assessment of demographics (N = 49), fertility desires and a conjoint survey of factors associated with reproductive decision-making. RESULTS Using conjoint analysis, we found that different decision paths exist for different types of women: Younger women and those with less education desired children if their partners wanted children; reproductive desires among those with less education, and with less HIV pregnancy-related knowledge, displayed a trend toward additional emphasis on their family's desires. Conversely, older women and those with more education appeared to place more importance on physician endorsement in their plans for childbearing. CONCLUSIONS Results of this study highlight the importance of ongoing preconception counselling for all women of reproductive age during routine HIV care. Counselling should be tailored to patient characteristics, and physicians should consider inclusion of families and/or partners in the process.
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Affiliation(s)
- Deborah Lynne Jones
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Ryan Cook
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - JoNell Efantis Potter
- Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Talya Miron-Shatz
- Ono Academic College, Kiryat Ono, Israel
- Center for Medicine in the Public Interest, New York, New York, United States of America
| | - Nahida Chakhtoura
- Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Andrew Spence
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Margaret M. Byrne
- Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Fletcher F, Ingram LA, Kerr J, Buchberg M, Richter DL, Sowell R. "Out of All of this Mess, I Got a Blessing": Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV. J Assoc Nurses AIDS Care 2016; 27:381-91. [PMID: 26781931 PMCID: PMC4903940 DOI: 10.1016/j.jana.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022]
Abstract
HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.
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Affiliation(s)
- Faith Fletcher
- Assistant Professor, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA
| | - Lucy Annang Ingram
- Assistant Professor, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Jelani Kerr
- Assistant Professor, University of Louisville School of Public Health & Information Sciences, Louisville, Kentucky, USA
| | - Meredith Buchberg
- Regional Coordinator, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Donna L. Richter
- Distinguished Professor Emeritus, University of South Carolina School of Public Health, Columbia, South Carolina, USA
| | - Richard Sowell
- Professor Nursing, Kennesaw State University Wellstar College of Health & Human Services, Kennesaw, Georgia, USA
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Wilkinson B, Arora KS. A Systematic Review on Confidentiality, Disclosure, and Stigma in the United States: Lessons for HIV Care in Pregnancy From Reproductive Genetics. New Bioeth 2016; 21:142-54. [PMID: 27124962 DOI: 10.1179/2050287715z.00000000067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The fields of HIV care in pregnancy and reproductive genetics have always been 'exceptional' in that patients are highly concerned about the potential for stigma and the corresponding need for privacy and confidentiality. However, the two fields have diverged in how they have addressed these concerns. The systematic review analyzed 61 manuscripts for similarities and differences between the fields of HIV care in pregnancy and reproductive genetics in the United States, with respect to privacy, confidentiality, disclosure, and stigma. The systematic review revealed that the field of HIV care in pregnancy has insufficiently addressed patient concerns about privacy, confidentiality, and stigma compared to the field of reproductive genetics. Failure to adequately protect confidentiality of HIV-positive patients, and failure to reduce stigma associated with HIV testing and treatment are deficiencies in the delivery of care to HIV-positive pregnant woman and barriers to reducing vertical transmission of HIV. Improvements in care and policy should mirror the field of reproductive genetics.
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Kreitchmann R, Megazzini K, Melo VH, Coelho DF, Watts DH, Krauss M, Gouvea MI, Duarte G, Losso MH, Siberry GK. Repeat pregnancy in women with HIV infection in Latin America and the Caribbean. AIDS Care 2015; 27:1289-97. [PMID: 26288031 PMCID: PMC4929011 DOI: 10.1080/09540121.2015.1050987] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intended and unintended pregnancies occur frequently among human immunodeficiency virus (HIV)-infected women. We evaluated the occurrence of repeat pregnancy and characteristics associated with this outcome among HIV-infected women in Latin America and the Caribbean who were participating in the National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Of the 1342 HIV-infected pregnant women enrolled in NISDI, 124 (9.2%) had one or more repeat pregnancies on study. Median time between the index delivery and date of conception of the subsequent pregnancy was 1.4 years (range 0.1-5.7). Younger age (odds ratio [OR] = 1.07, 95% confidence interval [CI]: 1.04-1.11 per one year decrease in age), hospitalization during the index pregnancy or up to six months post-partum [OR = 2.0, 95% CI: 1.2-3.4], and poor index pregnancy outcome (stillbirth or spontaneous/therapeutic abortion; OR = 3.4, 95% CI: 1.4-8.4) were associated with increased occurrence of repeat pregnancy in multivariable analysis. Among women with repeat pregnancies, the proportion receiving antiretroviral treatment (vs. prophylaxis) increased from 39.4% at the time of the index pregnancy to 81.8% at the time of the repeat pregnancy (p < 0.001). These results can help identify women most likely to benefit from reproductive counseling in order to assist with healthy pregnancy planning and prevention of unintended pregnancies.
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Affiliation(s)
- Regis Kreitchmann
- Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil, Professor Annes Dias 285, 90020090, Phone/Fax: 5551 32148008
| | - Karen Megazzini
- Westat, 1600 Research Blvd, Rockville, MD, 20850, USA, Tel: +1 301 366 6238
| | - Victor Hugo Melo
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil, Av. Alfredo Balena 190, 2th floor, Tel: +55 31 3409 9763
| | - Débora Fernandes Coelho
- Irmandade da Santa Casa de Misericordia de Porto Alegre, Rua Professor Annes Dias, 295 4 floor, Porto Alegre, RS, Brazil 90020-090, Tel/Fax: 55 51 3214.8008
| | - D. Heather Watts
- Office of the Global AIDS Coordinator, U.S. Department of State, Washington D.C., Tel: +1 202 663 2547
| | - Margot Krauss
- Westat, 1600 Research Blvd, Rockville, MD, 20850, USA, Tel: +1 301 279 4513
| | - Maria Isabel Gouvea
- Hospital Federal dos Servidores do Estado, Rua Sacadura Cabral, 178, Anexo IV, 4 andar, Rio de Janeiro, RJ – CEP 20221903, Brazil, Tel: 55 21 2233-0018 – Fax 55 21 2233-1551
| | - Geraldo Duarte
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, Brazil, CEP: 14049-900, Tel: +55 16 3602 2588
| | - Marcelo H. Losso
- HIV Unit, Hospital General de Agudos Jose Maria Ramos Mejia, Buenos Aires, Argentina, Urquiza 609, Pabellon de Clinicas, 2 Piso, C1221ADC Buenos Aires, Argentina, Tel: +5411 4127 0418
| | - George K. Siberry
- Maternal Pediatric Infectious Disease (MPID) Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, 6100 Executive Blvd., Room 4B11H, Bethesda, MD 20892-7510, Tel: +1 301 496 7350
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Adedimeji AA, Hoover DR, Shi Q, Gard T, Mutimura E, Sinayobye JD, Cohen MH, Anastos K. Sexual Behavior and Risk Practices of HIV Positive and HIV Negative Rwandan Women. AIDS Behav 2015; 19:1366-78. [PMID: 25488169 PMCID: PMC4461563 DOI: 10.1007/s10461-014-0964-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75 % of participants were HIV positive and ~50 % reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents' age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors.
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Affiliation(s)
- Adebola A Adedimeji
- Centre for Public Health Sciences, Albert Einstein College of Medicine, Mazer 515, 1300 Morris Park Avenue, Bronx, NY, 10461, USA,
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Akelo V, McLellan-Lemal E, Toledo L, Girde S, Borkowf CB, Ward L, Ondenge K, Ndivo R, Lecher SL, Mills LA, Thomas TK. Determinants and Experiences of Repeat Pregnancy among HIV-Positive Kenyan Women--A Mixed-Methods Analysis. PLoS One 2015; 10:e0131163. [PMID: 26120846 PMCID: PMC4488283 DOI: 10.1371/journal.pone.0131163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 05/31/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To identify factors associated with repeat pregnancy subsequent to an index pregnancy among women living with HIV (WLWH) in western Kenya who were enrolled in a 24-month phase-II clinical trial of triple-ART prophylaxis for prevention of mother-to-child transmission, and to contextualize social and cultural influences on WLWH's reproductive decision making. METHODS A mixed-methods approach was used to examine repeat pregnancy within a 24 month period after birth. Counselor-administered questionnaires were collected from 500 WLWH. Forty women (22 with a repeat pregnancy; 18 with no repeat pregnancy) were purposively selected for a qualitative interview (QI). Simple and multiple logistic regression analyses were performed for quantitative data. Thematic coding and saliency analysis were undertaken for qualitative data. RESULTS Eighty-eight (17.6%) women had a repeat pregnancy. Median maternal age was 23 years (range 15-43 years) and median gestational age at enrollment was 34 weeks. In multiple logistic regression analyses, living in the same compound with a husband (adjusted odds ratio (AOR): 2.33; 95% confidence interval (CI): 1.14, 4.75) was associated with increased odds of repeat pregnancy (p ≤ 0.05). Being in the 30-43 age group (AOR: 0.25; 95% CI: 0.07, 0.87), having talked to a partner about family planning (FP) use (AOR: 0.53; 95% CI: 0.29, 0.98), and prior usage of FP (AOR: 0.45; 95% CI: 0.25, 0.82) were associated with a decrease in odds of repeat pregnancy. QI findings centered on concerns about modern contraception methods (side effects and views that they 'ruined the womb') and a desire to have the right number of children. Religious leaders, family, and the broader community were viewed as reinforcing cultural expectations for married women to have children. Repeat pregnancy was commonly attributed to contraception failure or to lack of knowledge about post-delivery fertility. CONCLUSIONS In addition to cultural context, reproductive health programs for WLWH may need to address issues related to living circumstances and the possibility that reproductive-decision making may extend beyond the woman and her partner.
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Affiliation(s)
- Victor Akelo
- Kenya Medical Research Institute, Kisumu, Kenya
- * E-mail:
| | | | - Lauren Toledo
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- ICF International, Atlanta, GA, United States of America
| | - Sonali Girde
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- ICF International, Atlanta, GA, United States of America
| | - Craig B. Borkowf
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Laura Ward
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | | | | | - Shirley L. Lecher
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Lisa A. Mills
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Albright JN, Fair CD. Providers caring for adolescents with perinatally-acquired HIV: Current practices and barriers to communication about sexual and reproductive health. AIDS Patient Care STDS 2014; 28:587-93. [PMID: 25290765 DOI: 10.1089/apc.2014.0162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The population of adolescents and young adults (AYA) with perinatally-acquired HIV (PHIV) present challenges to HIV healthcare providers (HHCPs). Originally not expected to survive childhood, they are now living well into young adulthood. Little is known about the type of sexual and reproductive (SRH) information/services offered to AYA with PHIV by HHCPs. HHCPs (n=67) were recruited using snowball sampling, and completed an online survey. Providers' most frequently endorsed SRH topics discussed with both male and female patients included condom use (77.3%), STD prevention (73.1%), and screening (62.1%). Providers' reports indicated that females received significantly more education about SRH topics overall. The most frequently noted barriers to SRH communication included more pressing health concerns (53.0%), parent/guardian not receptive (43.9%), and lack of time during appointment (43.9%). Provider-reported SRH conversations with HHCPs were highly focused on horizontal transmission and pregnancy prevention. Salient social aspects of SRH promotion for AYAs with PHIV (e.g., managing disclosure and romantic relationships) were less commonly discussed, though such conversations may serve to reduce secondary transmission and enhance the overall well-being of AYA with PHIV. Findings indicated that further work must be done to identify strategies to address unmet SRH needs of the aging population of AYA with PHIV.
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Affiliation(s)
- Jamie N. Albright
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | - Cynthia D. Fair
- Department of Human Service Studies, Elon University, Elon, North Carolina
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Cook R, Hayden R, Weiss SM, Jones DL. Desire for fertility among HIV-seroconcordant and -discordant couples in Lusaka, Zambia. CULTURE, HEALTH & SEXUALITY 2014; 16:741-751. [PMID: 24815904 PMCID: PMC4090252 DOI: 10.1080/13691058.2014.902103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pregnancy rates and the desire to conceive are increasing among women living with HIV in Africa. However, attempts to conceive may increase the risk of HIV transmission or reinfection. A better understanding of factors influencing fertility desires would significantly contribute to programmes to meet the reproductive needs of women living with HIV. Using a couples-based approach, this paper explored fertility desires among HIV-seroconcordant and -discordant couples in Lusaka, Zambia. Participants were 208 heterosexual couples recruited from community health clinics and their respective catchment areas. Couples completed assessments on demographics, condom use, relationship quality and communication. Desire for children was often shared among couple members, and the strongest predictor of participants' desire for children was having a partner who wanted children. Additionally, the number of children participants had, their own reports of positive communication, and their partner's HIV serostatus influenced reproductive desires. Results support the involvement of both couple members in pre-conception counselling and pregnancy planning interventions. The inclusion of both partners may be a more effective strategy to respond to the reproductive needs of couples affected by HIV, enabling them to safeguard the health of both partners and infants.
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Affiliation(s)
- Ryan Cook
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida, USA
| | - Robert Hayden
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida, USA
| | - Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Florida, USA
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Fair C, Wiener L, Zadeh S, Albright J, Mellins CA, Mancilla M, Tepper V, Trexler C, Purdy J, Osherow J, Lovelace S, Kapetanovic S. Reproductive health decision-making in perinatally HIV-infected adolescents and young adults. Matern Child Health J 2014; 17:797-808. [PMID: 22736033 DOI: 10.1007/s10995-012-1070-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a "think tank" session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed.
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Evangeli M, Greenhalgh C, Frize G, Foster C, Fidler S. Parenting considerations in young adults with perinatally acquired HIV. AIDS Care 2013; 26:813-6. [DOI: 10.1080/09540121.2013.857755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Steiner RJ, Finocchario-Kessler S, Dariotis JK. Engaging HIV care providers in conversations with their reproductive-age patients about fertility desires and intentions: a historical review of the HIV epidemic in the United States. Am J Public Health 2013; 103:1357-66. [PMID: 23763424 DOI: 10.2105/ajph.2013.301265] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Provider-initiated conversations with people living with HIV about reproductive plans are lacking. Providers must know whether their patients want to bear children to tailor treatment and refer for HIV preconception counseling to help achieve patients' reproductive goals while minimizing transmission to partners and children. The early focus on men who have sex with men largely excluded consideration of the epidemic's impact on reproductive health. We used a historical review of the US epidemic to describe the problem's scope and understand if this legacy underlies the current neglect of reproductive planning. Drawing on peer-reviewed literature, we discuss key themes relevant to assessing and understanding attention to desires for children among HIV-positive people. We conclude with recommendations for addressing persistent stigma and enhancing patient-provider communication about reproductive intentions.
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Affiliation(s)
- Riley J Steiner
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Childbearing Decision Making: A Qualitative Study of Women Living with HIV/AIDS in Southwest Nigeria. AIDS Res Treat 2012; 2012:478065. [PMID: 23320152 PMCID: PMC3539429 DOI: 10.1155/2012/478065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 11/07/2012] [Accepted: 11/13/2012] [Indexed: 11/17/2022] Open
Abstract
Using the PEN-3 model, the purpose of this qualitative study was to understand the factors responsible for the childbearing decisions of women living with HIV/AIDS (WLHA) in Lagos, Nigeria. Sixty WLHA who sought care at a teaching hospital in Lagos were recruited to participate in in-depth interviews. The average age of the participants was 30 years, and 48 participants were receiving antiretroviral therapy. Healthcare and spiritual practices, healthcare provider-patient communication about childbearing, and husband/partner support emerged as factors that contribute to the childbearing decisions of WLHA. The findings reveal the importance of discussing sexual reproductive health and childbearing issues with WLHA in the healthcare context prior to pregnancy.
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Fair C, Albright J. "Don't tell him you have HIV unless he's 'the one'": romantic relationships among adolescents and young adults with perinatal HIV infection. AIDS Patient Care STDS 2012. [PMID: 23199192 DOI: 10.1089/apc.2012.0290] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Individuals with perinatally-acquired HIV (PHIV) are surviving into young adulthood. Previous literature has explored the sexual behavior of those with PHIV. However, their perspectives on navigating romantic relationships are not well understood. Semi-structured interviews were conducted with 35 young adults living with PHIV recruited from two pediatric infectious disease clinics in the southeast United States. The majority of participants were African American (n=27, 77.2%), female (n=23, 65.7%), and the mean age was 20.7 (range 15-30) years. Questions focused on experiences with dating and romantic relationships as well as relationship advice for others living with HIV. Transcribed interviews were coded for emergent themes. Qualitative analyses revealed that the majority of participants have dated and struggled with their HIV status in their intimate relationships. The majority of those who disclosed their HIV status to past partners had experienced some form of rejection. However, several participants reported receiving support upon disclosure. Some individuals had never disclosed to a romantic partner, but carefully managed intimacy by delaying dating, terminating relationships, and "taking it slow." Advice fell into two broad categories: "be safe" which referred to the physical protection of self and partners, as well as emotional protection from possible rejection. The second advice category was basic encouragement which stressed the importance for young adults living with HIV to have hope that they would find a supportive partner and to be patient. The focus of education must include not only transmission risk factors, but also developing and maintaining healthy relationships in the context of a highly stigmatized illness.
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Affiliation(s)
- Cynthia Fair
- Department of Human Service Studies, Elon University, Elon, North Carolina
| | - Jamie Albright
- Department of Public Health Studies, Elon University, Elon, North Carolina
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Ramos AN, Matida LH, Hearst N, Oliveira FA, Heukelbach J. High occurrence of HIV-positive siblings due to repeated mother-to-child transmission in Brazil. AIDS Care 2011; 24:601-5. [PMID: 22148871 DOI: 10.1080/09540121.2011.630361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pregnancies in women without knowledge of their HIV-positive status increase the risk of mother-to-child transmission, and of disease progression. This study aimed to characterize the frequency of multiple pregnancies and of HIV-positive children in the family, during HAART era. We analyzed data of a national multicenter cohort study among Brazilian children with AIDS diagnosed between 1999 and 2002. In total, 945 children and their 928 mothers were included. Five hundred and ninety (64.6%) women had a history of multiple pregnancies, and 49.5% attended prenatal care (mean: 3.5 consultations; SD 3.6). In 483 child cases, HIV status of the sibling was known; 130 (26.9%) of these were infected with HIV. In 38.5% of cases, the child with AIDS included in the cohort study was the first case in the family. Despite the overall positive results of the Brazilian control policy of HIV/AIDS, our study shows that HIV infection in pregnant women was often undetected and that consequently there was a high frequency of repeated HIV-infected children. There is a need to improve comprehensive prenatal and postnatal care of Brazilian women. HIV-affected families are most vulnerable and should be targeted by specific control programs, preventing additional HIV infections in other children.
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Affiliation(s)
- Alberto N Ramos
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil.
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