Pregnancy Planning Among Women Living With HIV in the US
Pregnancy Planning Among Women Living With HIV in the US
There are approximately 280,000 HIV-infected women in the United States and an estimated 140,000 serodifferent couples (in which only 1 member of the partnership has HIV) living in the United States. The number of HIV-infected women giving birth in the United States increased by approximately 30% between 2000 and 2006. Research on pregnancy intention in HIV-infected women is limited. To address prevention of sexual HIV transmission, a family planning discussion may focus on condoms to prevent both pregnancy and HIV/sexually transmitted infection (STI) transmission. Although condoms decrease the risk of STI transmission, they are only 83% effective in preventing pregnancy and counterproductive for couples who desire pregnancy. Hence, prevention of HIV transmission through condoms and a woman's desire for pregnancy are in clear conflict. In addition, recent research indicates that antiretroviral (ARV) use by an HIV-infected partner reduces HIV transmission risk by 96% in serodifferent heterosexual couples. Preexposure prophylaxis has been shown to reduce HIV transmission by 62%–73%; a 90% reduction is reported with confirmed adherence to preexposure prophylaxis. With improved options for safe conception and risk of perinatal HIV transmission potentially at less than 1% for women with undetectable viral load at delivery, there is now greater opportunity for providers and patients to engage in patient-centered conversations on how HIV-infected women can both achieve pregnancy safely and avoid perinatal HIV transmission. Given the limited data on pregnancy intentions among HIV-infected women in the United States, we sought to assess pregnancy intentions and factors associated with unplanned pregnancies in this multisite cohort of HIV-infected pregnant women in the United States.
Background
There are approximately 280,000 HIV-infected women in the United States and an estimated 140,000 serodifferent couples (in which only 1 member of the partnership has HIV) living in the United States. The number of HIV-infected women giving birth in the United States increased by approximately 30% between 2000 and 2006. Research on pregnancy intention in HIV-infected women is limited. To address prevention of sexual HIV transmission, a family planning discussion may focus on condoms to prevent both pregnancy and HIV/sexually transmitted infection (STI) transmission. Although condoms decrease the risk of STI transmission, they are only 83% effective in preventing pregnancy and counterproductive for couples who desire pregnancy. Hence, prevention of HIV transmission through condoms and a woman's desire for pregnancy are in clear conflict. In addition, recent research indicates that antiretroviral (ARV) use by an HIV-infected partner reduces HIV transmission risk by 96% in serodifferent heterosexual couples. Preexposure prophylaxis has been shown to reduce HIV transmission by 62%–73%; a 90% reduction is reported with confirmed adherence to preexposure prophylaxis. With improved options for safe conception and risk of perinatal HIV transmission potentially at less than 1% for women with undetectable viral load at delivery, there is now greater opportunity for providers and patients to engage in patient-centered conversations on how HIV-infected women can both achieve pregnancy safely and avoid perinatal HIV transmission. Given the limited data on pregnancy intentions among HIV-infected women in the United States, we sought to assess pregnancy intentions and factors associated with unplanned pregnancies in this multisite cohort of HIV-infected pregnant women in the United States.
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