Reproductive choices among HIV-positive women

Abstract

The objective of this study was to describe the characteristics of HIV-positive women who become pregnant, who choose to get sterilized, and who have an elective abortion after an HIV diagnosis. All HIV-infected women between the ages of 14 and 35 years (N = 403) who were enrolled in the HIV Outpatient Program in New Orleans, U.S.A., between 1987 and 1995 were included in the study. Medical records were abstracted for reproductive outcomes and demographic and medical characteristics. The mean age of the participants was 25.8 years, 83% were African American, 71% were single, 20% had a history of i.v. drug use, and 35% had a history of non-i.v. drug use at entry. Mean follow-up time was 2.9 years. The overall incidence of pregnancy subsequent to HIV diagnosis was 6.3% per person-year of observation. Twenty-four percent of the population underwent a sterilization procedure subsequent to HIV diagnosis, and 25% of the women who became pregnant subsequent to diagnosis had an induced abortion. Factors associated with subsequent pregnancy in multivariate analysis included young age and a history of sexual assault. Factors associated with subsequent sterilization in multivariate analysis were CD4 count over 200, having one or more living children, and not living with a family member. Factors associated with subsequent abortion included being White and non-single. Sexual assault history and living with a sex partner were associated with abortion at the p < 0.1 level. The study concludes that HIV-infected women tend to have lower rates of pregnancy and higher rates of sterilization and abortion than their uninfected counterparts. Counseling messages that are culturally sensitive, non-coercive, and that take into consideration the complexities of the decision-making process should be standardized for all HIV-infected women so that they can make informed decisions.