Knowledge of HIV antibody status and decisions to continue or terminate pregnancy among intravenous drug users

Abstract

We studied decisions to continue or terminate pregnancy among human immunodeficiency virus (HIV)-seropositive (+) and -seronegative (-) intravenous drug users informed of HIV antibody status before 24 weeks' gestation. Fourteen (50%) of 28 HIV+ vs 16 (44%) of 36 HIV- women chose to terminate their pregnancies. In retrospective interviews, HIV+ women were more likely to have perceived their risk of perinatal HIV transmission to be greater than or equal to 50% and, among those who terminated pregnancy, to cite this concern as an important factor in their decision. However, decisions to terminate pregnancy were predicted more readily by pregnancy-related variables such as prior elective abortion, a negative emotional reaction to pregnancy, and whether the pregnancy had been unplanned. Women who were HIV+ and chose to continue their pregnancies cited the desire for a child, religious beliefs, and family pressure as the most important factors in their decisions. Results indicate that while concerns about perinatal transmission of HIV may lead to decisions to terminate pregnancy in certain cases, there may be other determinants of pregnancy decisions in this population. Counseling of HIV-infected women must address not only perinatal transmission but also the sociocultural and behavioral context in which pregnancy decision making takes place.

KIE: Decisions to terminate or continue pregnancy among human immunodeficiency virus (HIV) seropositive (+) and seronegative (-) intravenous drug users in a New York City methadone maintenance treatment program were examined to determine the effect of knowledge of HIV status on decisions about pregnancy in HIV infected and at-risk women. All women were informed of their HIV antibody status prior to 24 weeks gestation. In retrospective interviews, seropositive women who terminated pregnancy cited fear of AIDS for themselves or their infants as an important factor in their decision. However, pregnancy termination for both HIV+ and HIV- women was best predicted by a prior history of elective abortion, whether the pregnancy was unplanned, and whether the woman reported feeling sad or scared upon learning she was pregnant. Desire for a child and religious beliefs were reported as the main reasons to continue pregnancy by both groups.