Communication with HIV providers about childbearing desires among women living with HIV in the US and Brazil
S. Finocchario Kessler1, M. Sweat1, J. Anderson2, J. Dariotis3, F. Inacio Bastos4, M. Malta4, N. Bertoni4, D. Kerrigan1, Rio Collaborative Group
1Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, United States, 2Johns Hopkins School of Medicine, Obstetrics & Gynecology, Baltimore, United States, 3John Hopkins Bloomberg School of Public Health, Population, Family & Reproductive Health, Baltimore, United States, 4Oswaldo Cruz Foundation - FIOCRUZ, Rio de Janeiro, Brazil
Background: In settings with secure access to HIV treatment, more HIV-infected women are pursuing childbearing. Early identification of women with such plans is essential to maximize benefits of HIV-preconception counseling.
Methods: We utilized survey data from Baltimore, USA and Rio de Janeiro, Brazil comparing demographic characteristics, fertility desires and intentions, and communication regarding future childbearing among reproductive age women (15-44 yrs) living with HIV. Multivariate logistic regression detected significant differences between groups of women, controlling for age, parity, race and antiretroviral therapy.
Results: While at least one-third of HIV-infected women in each sample reported the desire to have a child in the future, HIV-infected women receiving care in Baltimore (n=181, mean age=32.4 yrs, 89% African American, nulliparous=35% , average 1.77 children, 70% on HAART) were significantly more likely than HIV-infected women receiving care in Rio (n=180, x age=35.3 yrs, nulliparous=19%, 75.5% of color, average 1.81 children, 68% on HAART) to desire (AOR 2.45, p=0.001), and intend (AOR 4.02, p< 0.001) to have a child in the future. Likewise, women in Baltimore were more likely to have talked with their partner (AOR 2.14, p< 0.001) and their doctor (AOR 1.85, p=0.02) about a future pregnancy. Communication regarding future childbearing plans between HIV-infected women and HIV-providers remains low in both groups; as only 45% and 48% of those intending to become pregnant reported discussing a future pregnancy with their doctor in Baltimore and Rio, respectively. Accepting attitudes regarding childbearing were similar; with 67% (Baltimore) vs. 58% (Rio) either somewhat or strongly agreeing that it is okay for a HIV-infected woman to have a child.
Conclusion: While higher in Baltimore, childbearing desires and intentions among HIV-infected women in both cities necessitate open, provider-initiated communication to maximize benefits of existing services to reduce transmission risk to partners and infants, while protecting maternal health.
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