Do HIV-Infected Women Want to Discuss Reproductive Plans with Providers, and Are Those Conversations Occurring?

Abstract

The purpose of the study is to assess frequency and determinants of discussions between HIV-infected women and their HIV providers about childbearing plans, and to identify unmet need for reproductive counseling. We conducted a cross-sectional, audio computer-assisted self-interview (ACASI) among 181 predominately African American HIV-infected women of reproductive age receiving HIV clinical care in two urban health clinics. We used descriptive statistics to identify unmet need for reproductive counseling by determining the proportion of women who want to, but have not, discussed future reproductive plans with their primary HIV care provider. Multivariate analysis determined which factors were associated with general and personalized discussions about pregnancy. Of the 181 women interviewed, 67% reported a general discussion about pregnancy and HIV while 31% reported a personalized discussion about future childbearing plans with their provider. Of the personalized discussions, 64% were patient initiated. Unmet reproductive counseling needs were higher for personalized discussions about future pregnancies (56%) than general discussions about HIV and pregnancy (23%). Younger age was the most powerful determinant of provider communication about pregnancy. A significant proportion of HIV-infected women want to talk about reproductive plans with their HIV provider; however, many have not. HIV care providers and gynecologists can address this unmet communication need by discussing reproductive plans with all women of childbearing age so that preconception counseling can be provided when appropriate. Providers will miss opportunities to help women safely plan pregnancy if they only discuss reproductive plans with younger patients.

“We Weren't Using Condoms Because We Were Trying to Conceive”: The Need for Reproductive Counseling for HIV-Positive Women in Clinical Care

“…These data highlight the need for informed reproductive counseling and compliment previously published quantitative data about future childbearing plans and provider communication among the same priority population. 3,21 Based on the emergent themes, we offer the following recommendations to enhance HIV provider-patient communication about the reproductive health needs and desires of PLHA in an effort to minimize health risks and maximize attainment of reproductive goals.…”

“…Such qualitative data describing women's communication with providers about childbearing in the United States has not yet been published, and identifies some positive efforts being made in the context of a system that does not implement routine reproductive counseling with referral to preconception counseling or for contraception management. Lastly these qualitative data serve to triangulate and further expand upon previously published quantitative data that addressed the same themes with the same study population, 3,21,29 and can generate hypotheses to pursue in future larger scale research.…”

“…Nearly all (19/20) of these participants are a subset of a larger quantitative study regarding childbearing intentions and both partner and provider dynamics. 3,21 Analytic strategy…”

HIV and Preconception- a Review

“…It is important to counsel these women to adopt safe sexual practises to prevent acquisition of STI's and additional strains of HIV which are virulent or resistant to therapy. It is advisable to use effective contraception and defer pregnancy until low or undetectable viral load and good immune function is achieved [14,15]. …”

“…There was a group of women who were ambivalent regarding their reproductive intention and hence did not receive counselling. Hence it was recommended by this study that providers initiate discussions regarding fertility plans with all women of reproductive age [15].…”