16th International AIDS Conference


Toronto, Canada - August 13 - 18, 2006

KNOWLEDGE OF HIV POSITIVE STATUS DECREASES PREGNANCY INTENTION AND INCREASES CONTRACEPTIVE USE AMONG WOMAN IN LILONGWE, MALAWI

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. WeAc0103

Hoffman I.1, Chanza H.2, Martinson F.2, Chilongozi D.2, Powers K.1, Hosseinipour M.2, Dziza E.2, Kachipa E.2, Mphande C.2, Nkhalamba T.2, Stephenson R.3, Tsui A.4
1 University of North Carolina, Chapel Hill, NC, United States, 2 UNC Project, Lilongwe, Malawi, 3 Emory University, Atlanta, GA, United States, 4 Johns Hopkins University, Baltimore, MD, United States

BACKGROUND: Few programs for the prevention of mother-to-child HIV transmission are designed to reduce pregnancies among HIV+ women. We conducted an observational cohort study to inform policy-makers in Malawi about this issue.

METHODS: Following informed consent, women with unknown HIV status recruited from clinical service settings in Lilongwe had a questionnaire administered about their pregnancy intention and reproductive history. Following HIV VCT, HIV+ women were enrolled and followed quarterly for 1 year. At visits, a physical exam and pregnancy test were performed, and the same questionnaire administered. Women received free HIV care and reproductive services/information during study visits. Women who became pregnant were censored from further analysis.

RESULTS: 250 of 787 (32%) women tested HIV+ and 230 enrolled. Median age: 26; median CD4: 271; 71% married. 49/230 (21.3%) lost to follow-up, including 18 (7.8%) deaths. 27 became pregnant during follow-up for an incidence of 15 pregnancies per100 person-years. Of the 27 pregnancies, only 14 (52%) occurred among women who claimed at baseline they wanted another child.
Before HIV Test Results 1 Year After Receiving + Results
All*
(230)		 CD4
<200
(83)		 CD4
≥200
(147)		 All*
(161)		 CD4
<200
(56)		 CD4
≥200 (105)		 p-value*
Wants
another child		 35% 22% 42% 13% 9% 15% <0.0001
Using
contraceptives		 38% 29% 43% 49% 36% 56% 0.09
Condom use 4% 4% 4% 5% 5% 5% 0.79

CONCLUSIONS: There was a significant reduction in women wanting pregnancy after being notified of their positive HIV status, and an accompanying increase in the use of contraceptives. Condom use among these HIV+ women was disturbingly low. Despite counseling and the availability of contraceptive services, incidence of pregnancy was high, even among women reporting they did not want another child. Immune status affects both pregnancy intention and contraceptive use. Culturally sensitive programs that assist HIV+ women in making sound reproductive choices are urgently needed.

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2006-08-13
WeAc0103

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