Representation of Women and Pregnant Women in HIV Research: A Limited Systematic Review

Abstract

BackgroundHIV-related outcomes may be affected by biological sex and by pregnancy. Including women in general and pregnant women in particular in HIV-related research is important for generalizability of findings.ObjectiveTo characterize representation of pregnant and non-pregnant women in HIV-related research conducted in general populations.Data SourcesAll HIV-related articles published in fifteen journals from January to March of 2011. We selected the top five journals by 2010 impact factor, in internal medicine, infectious diseases, and HIV/AIDS.Study Eligibility CriteriaHIV-related studies reporting original research on questions applicable to both men and women of reproductive age were considered; studies were excluded if they did not include individual-level patient data.Study appraisal and synthesis methods.Articles were doubly reviewed and abstracted; discrepancies were resolved through consensus. We recorded proportion of female study participants, whether pregnant women were included or excluded, and other key factors.ResultsIn total, 2014 articles were published during this period. After screening, 259 articles were included as original HIV-related research reporting individual-level data; of these, 226 were determined to be articles relevant to both men and women of reproductive age. In these articles, women were adequately represented within geographic region. The vast majority of published articles, 183/226 (81%), did not mention pregnancy (or related issues); still fewer included pregnant women (n=33), reported numbers of pregnant women (n=19), or analyzed using pregnancy status (n=9).LimitationsData were missing for some key variables, including pregnancy. The time period over which published works were evaluated was relatively short.Conclusions and implications of key findings.The under-reporting and inattention to pregnancy in the HIV literature may reduce policy-makers’ ability to set evidence-based policy around HIV/AIDS care for pregnant women and women of child-bearing age.

HIV Risk Reduction Interventions Among Substance-Abusing Reproductive-Age Women: A Systematic Review

“…This is a concerning gap considering that both sex- and drug-related HIV risk behaviors are common among pregnant women who abuse substances (Baker et al, 2001; Ramsey, Bell, & Engler-Field, 2010), and if infected with HIV, pregnant women can infect their child via vertical transmission. This finding is in accordance with another systematic review that revealed that pregnant women tend to be underrepresented in HIV/AIDS research (Westreich et al, 2013). Second, results from our study suggest that no studies during the last 10 years have been conducted with women 15 to 17 years old who abuse substances, which is concerning since HIV is one of the leading causes of death among women as young as 15 through age 49 throughout the world (World Health Organization, 2013).…”

“…Moreover, consuming alcohol and smoking, ingesting, or inhaling drugs such as alcohol, crack cocaine, methamphetamine, and amyl nitrite (poppers) are also associated with increased risk for HIV infection by reducing users’ inhibitions to engage in risky sexual behavior, impairing judgment, and enhancing libido (Colfax & Shoptaw, 2005; Des Jarlais et al, 2007; Walley, Krupitsky, & Cheng, 2008). Exchange of sex for drugs or money, another risk factor for HIV infection, is common among those who abuse injection and non-injection drugs (Baker, Heather, Wodak, & Lewin, 2001; Draus & Carlson, 2009; El-Bassel et al, 1997; Inciardi, 1995; Meader et al, 2013; Westreich, Rosenberg, Schwartz, & Swamy, 2013). Of note, the risk of becoming infected with HIV via needle sharing varies in different parts of the world.…”

Fertility-related research needs among women at the margins

“…Nevertheless, pregnant women remain under-represented within general HIV prevention, treatment, and care studies. 54 Furthermore, as efforts to eliminate vertical HIV transmission expand, including growing access to lifelong antiretroviral therapy for pregnant women independent of CD4 staging to optimize their own health outcomes as well as the child's, building the evidence base of effective interventions to reduce loss to follow-up among post-partum women and infants is needed. 55 Infant and child survival depend on the long-term health outcomes of mothers, and human rights-affirming approaches to support the health of mothers living with HIV will also optimize family health outcomes.…”

Advancing HIV research with pregnant women

“…Mirroring gaps discussed in the literature [19, 20, 21], they identified areas of need including pregnancy safety and dosing information for newer ARVs; optimal treatment following PMTCT; safety and efficacy of emerging preventive strategies, such as microbicides, vaginal rings, oral pre-exposure prophylaxis (PrEP), and vaccines; treatment for HIV co-infections, including tuberculosis and malaria; as well as guidance for diagnostics. One commonly cited example was efavirenz, for which a lack of safety data in pregnancy resulted in reticence to use the drug, leading not only to limited treatment options for pregnant women, but also potentially poorer health outcomes given regimen changes and adverse effects associated with alternative ARVs.…”