The aim of this paper is to describe the adherence of African HIV+ women to the counselling provided after announcement of the result of the HIV test during pregnancy, focusing on early weaning to reduce post-natal transmission, protected sexual intercourse to avoid sexual transmission, and contraceptive use to avoid unexpected pregnancies. In 1999-2000, a questionnaire on sexual and reproductive behaviours was administered to 149 HIV+ women followed in post-partum, informed and counselled in the ANRS 049 DITRAME project in Abidjan. Côte d'Ivoire. Duration of breastfeeding, post-partum amenorrhea and abstinence, contraceptive use and condom use were measured. Incidence of pregnancies during the first 24 months post partum was estimated and modelled by a Cox regression model. Average duration of breastfeeding was 7.9 months, average duration of post partum abstinence was 12.0 months, and 39% of women used contraceptives at the time of the survey. Frequency of condom use was 13%. Incidence of pregnancies was 16.5 per 100 women-years at risk. Half of these pregnancies were not desired and a third were terminated by induced abortion. The significant determinants of the pregnancy occurrence were the death of the previous child, the cessation of breastfeeding, the cessation of the post partum abstinence, and higher education. In conclusion, if counselling on early weaning can be followed by the HIV+ women, it is not easily the case for condom and contraceptive use. Hence, pregnancy incidence in the post-partum follow-up was high. The main strategy of these HIV+ women to avoid unexpected pregnancies as well as sexual transmission of HIV seems to be an increase of the duration of post-partum abstinence. The most educated women who cannot easily adopt this strategy are particularly exposed to unwanted pregnancies.

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The child desire of HIV-positive women undergoes several alterations. The present study describes those along with the defence mechanisms and fantasies experienced by such women in Abidjan, Côte d'Ivoire, and the impact of the psychological intervention. We employed a story case approach, that is, we sought information concerning the women's background and personal history along with individual interviews. The investigation was based on a sample of six story cases extracted from a cohort of HIV-positive women who participated in clinical psychology consultations, as part of a research programme aimed at reducing mother-to-child transmission of HIV (ANRS, 049 a trial). The time of conduction of the clinical cohort study was 18 months. Each woman was seen two to four times in a period of 2 months. In general, the child women of HIV-positive women strengthened. This was true for the women who learned their positive serostatus during pregnancy, as well as for those who had prior knowledge of it. In order to cope with the anxieties elicited by their positive serostatus, which implied that they may either give birth to an infected child or not be able to bear any more children, the women unconsciously set forth defence mechanisms, such as denial, aggressive projection, rationalization and regression. The psychological intervention thus becomes a necessary outlet. As a result, it is recommended that some psychosocial interventions be included in actions that are undertaken on behalf of HIV-positive women. Such interventions, however, should take into account the patients' culture.