Understanding High Fertility Desires and Intentions Among a Sample of Urban Women Living with HIV in the United States

Abstract

To assess childbearing motivations, fertility desires and intentions, and their relationship with key factors, we conducted a cross-sectional survey among 181 HIV-infected women of reproductive age (15-44 years) receiving clinical care at two urban health clinics. Fertility desires (59%) and intentions (66% of those who desired a child) were high among this predominately African American sample of women, while the proportion with accurate knowledge of mother-to-child transmission (MTCT) was low (15%). Multivariate regression analyses identified factors significantly associated with the intention to have a child. Notably, age and parity did not remain significant in the adjusted model. The discrepancies between expressed desires and intentions for future childbearing, and the strong role of perceived partner desire for childbearing emphasize the need for universal reproductive counseling to help women living with HIV navigate their reproductive decisions and facilitate safe pregnancies and healthy children.

“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.…”

“…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…”

“…1 A growing number of studies document the intention to initiate or continue childbearing among PLHA. [1][2][3] These intentions result in births as demonstrated by the 150% increase in the live birth rate among HIV-positive women in the United States since ART became widely available in 1996. 4 In high resources settings, adherence to appropriate ART and avoidance of breastfeeding can successfully reduce motherto-child transmission (MTCT) of HIV to less than 1%, 5 and quality perinatal HIV care can avoid any increase in adverse pregnancy or neonatal outcomes.…”

“…9 In addition to HIV, other health conditions (e.g., hypertension, diabetes) require appropriate intervention prior to pregnancy to avoid adverse outcomes for women and infants. Given this context, and the frequency of serodiscordant partnerships, 3 it is critical for HIV providers to work with PLHA to carefully plan or avoid pregnancies. The recent HPTN 052 findings demonstrating a 96% reduction in HIV transmission to serodiscordant partners with the use of early ART initiation, 10 provides a feasible strategy for safer conception among serodiscordant couples.…”

Behavioral interventions to promote condom use among women living with HIV: a systematic review update

“…Gender inequities have been cited as the main reason for unprotected sexual practices among women living with HIV 10,12,16 , including precarious socioeconomic conditions, low educational level, gendered power imbalances, intimate partner violence, and partner alcohol abuse. Reproductive intentions have also been emphasized as a reason for not using condoms 17 .…”