Health Needs of HIV-Infected Women in the United States: Insights from The Women Living Positive Survey

HIV-infected women of color (WOC) face particular barriers to accessing HIV medical care. To understand the impact of physical symptoms, social support, and self-determination on barriers to care, we interviewed HIVinfected women of color. HIV-infected WOC (N = 141), attending an academic infectious disease clinic for HIV care in North Carolina, completed the Barriers to Care scale and were categorized as reporting a history of low (less than four of eleven barriers) or high (five or more) barriers to care. Binomial regression was used to estimate prevalence ratios and risk differences of reported barriers to care and its correlates such as depression, anxiety, illness-severity, psychological abuse, social support, treatment-specific social support, and self-determination (autonomy, relatedness, competency). A lower risk of reporting five or more barriers to care was associated with higher levels of autonomy (PR = 0.93, 95% CI: 0.89, 0.96), relatedness (PR = 0.92, 95% CI: 0.89, 0.94), competency (PR = 0.93, 95% CI: 0.87, 0.98), and social support (PR = 0.24, 95% CI: 0.81, 0.81). Depression, illness severity, and psychological abuse were associated with a greater risk of having five or more barriers to care. There are multiple social and psychological factors that contribute to perceived barriers to HIV care among WOC in the southeastern USA. Interventions that promote social support and increase individual self-determination have the potential to improve access to HIV care for WOC.

Section: Discussionmentioning

confidence: 99%

Barriers to HIV Care for Women of Color Living in the Southeastern US Are Associated with Physical Symptoms, Social Environment, and Self-Determination

Toth

Messer

Quinlivan

2013

“…30 The quantitative findings that are part of this larger study, the Women Living Positively Study, 25 and a very recent survey among 93 HIV-positive male and female patients 22 are the only published data we are aware of that assess communication with HIV providers about safer childbearing options in the United States. While such research in the United States is scant from the patient perspective, it is nearly nonexistent from the provider perspective.…”

Section: Reproductive Counseling For Hiv-positive Women Neededmentioning

confidence: 94%

“…Many PLHA in the United States 25 and globally 26,27 feel reluctant to express interest in childbearing and fear disapproval from providers, thereby highlighting the importance of provider-initiated communication. It is also likely that few infectious disease providers feel confident to initiate fertility-related discussions as this is not their area of expertise.…”

Section: Implications For Practicementioning

confidence: 99%

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

Finocchario-Kessler

Mabachi

Dariotis

et al. 2012

Although a significant number of HIV-positive women intend to have children in the future, few work with providers to safely plan pregnancy. We conducted 20 semistructured in depth interviews with HIV-positive adolescent and adult women receiving HIV clinical care in an urban setting. Participants were purposively sampled to include diversity in age and childbearing plans. Interview transcripts were analyzed and coded independently by two study team members before reaching consensus on emergent themes. Among this sample of HIV-positive women (mean age = 27.9, 95% African American, 50% on antiretroviral therapy [ART], 65% want a biological child), only 25% reported discussing their childbearing goals with their HIV provider. Women actively trying to conceive recognized the risk to themselves and their partner, but had not talked with their provider about safer conception strategies. Data regarding provider communication about childbearing were organized by the following emergent themes: (1) confusion and concern on how to conceive safely, (2) provider characteristics or dynamics that influenced communication, and (3) provider guidance offered regarding childbearing. Even in this unique study setting in which referrals for preconception counseling are possible, women were unaware of this specialized service. Provider initiated reproductive counseling is needed to strategically avoid or plan pregnancy and reduce risk of transmission to partners and infants rather than leaving it to chance, which can have major health implications.

“…The Women Living Positive Survey reported that about half of women who had a prior pregnancy or who were considering pregnancy had a care provider inquire about their interest in childbearing, and approximately 42% of women with current or prior pregnancies were unaware of treatment options for pregnant women with HIV. 4 Additional research suggests that a minority of HIV-positive women have personalized discussions regarding childbearing plans with providers, and most of these are self-initiated. 36 Understanding sociodemographic factors influencing DFP is important for informing providers who may be counseling young women regarding pregnancy planning.…”

mentioning

confidence: 99%

Desire for Pregnancy and Risk Behavior in Young HIV-Positive Women

Finger

Clum

Trent

et al. 2012

This cross-sectional study utilized data from 130 young women with behaviorally acquired HIV to examine the association between desire for pregnancy (DFP) and both sociodemographic variables and sexual risk behaviors. A single item was utilized to assess DFP. Bivariate and multivariate regression analyses were conducted. At the bivariate level, DFP was associated with increased rates of intercourse, decreased condom use, increased partner concurrency, increased rates of unprotected sex with a nonconcordant partner, and a higher number of previous sexually transmitted infections (STIs). Multivariate analyses suggested that DFP was associated with increased likelihood of recent intercourse, condom-unprotected sex, and oral sex. DFP was related to few sociodemographic variables but was associated with having fewer children currently, a history of victimization, and decreased rates of disclosure of HIV status. The few sociodemographic variables that were associated with DFP suggest that social relationships may play a role in DFP. DFP was associated with sexual behaviors that may place young women at risk for STI acquisition and secondary HIV transmission to partners. Health care providers should assess DFP in routine HIV care, providing education about fertility options, interventions for vertical transmission, family planning, and risk reduction counseling.