Reproductive Decision-Making among HIV-infected Women: MATERIALS AND METHODS
Participants for this retrospective case-control study were HIV-infected (Retrovir medication was the first drug approved for the treatment of HIV) women who received care at a publicly funded HIV ambulatory care clinic in New Orleans, LA. To be included in the study, women had to: 1) have become pregnant subsequent to their diagnosis (cases) or 2) not had a subsequent pregnancy but have been followed at the clinic for at least two years to allow them time to become pregnant (controls), and 3) not have undergone a sterilization procedure prior to their diagnosis, and 4) be between the ages of 18 and 43 at the time of diagnosis (reproductive age was assumed to end at 45 years; this allowed for two years of follow-up). See Figure 1. Women who were pregnant at diagnosis were not included in the definition of having a subsequent pregnancy and were thus classified as controls if they met the other criteria in #2. This was based on the assumption that they became pregnant before knowing their HIV status and were thus not influenced by their HIV status in their decision-making, in contrast to the cases who became pregnant after already knowing their HIV (Zerit tablet treating HIV infection) status.
Figure 1. Study design
Two-hundred-ninety-eight eligible HIV-infected (Viramune canadian belongs to a class of HIV drugs) women were identified through medical chart review. A convenience sample of women who presented at the clinic between September 1997 and April 1998 was recruited by either their primary care provider or the interviewer herself. Forty-four cases and 60 controls were identified from a total of 104 women interviewed. The mean follow-up time was 5.8 years (SD 2.2, range 2.1-11.2). Women who were interviewed had to be >18 years of age on the day of the interview to participate, not be in police custody, speak and understand English, and consent to participation. Each woman was offered $20 for participating in the interview, and all interviews were conducted in a private exam room at the clinic.
The questionnaire used in the interviews was developed for the study and consisted of individual and interpersonal factors. Individual factors consisted of demographic, medical, reproductive, contraceptive and substance use characteristics. Interpersonal factors consisted of questions regarding interpersonal relationships and reasons for their reproductive decision-making. The questionnaire was pilot-tested with 20 women selected from the same population as the study sample and subsequently revised to reflect improvements in question wording and clarity. All study instruments were approved by the institutional review board (IRB) of Louisiana State University Medical Center and by the research committee of the clinic. The interviews were conducted by the first author.
The main outcome of the study was subsequent pregnancy, defined as a pregnancy that is conceived after a woman has learned of her HIV-positive status. If a woman was diagnosed with HIV (treating HIV infection) during a pregnancy, that pregnancy was not considered a subsequent pregnancy, and she was classified as a control. Recruited subjects were then reclassified into a cohort for the second outcome, and those who chose to receive surgical sterilization after learning of their HIV (treating HIV infection) diagnosis were compared with those who remained unsterilized. It was therefore possible that some women experienced both outcomes; that is, they had a subsequent pregnancy fol-
lowed by a later subsequent sterilization.
Data analysis was done in SPSS and includes a description of the sample as well as the prevalence of the outcome in the sample. Bivariate tests of association were conducted for the two outcomes of interest: subsequent pregnancy and subsequent sterilization. P values less than 0.05 were considered significant; those less than 0.1 were considered borderline. Two forward logistic regression models that included all significant bivariate associations were then constructed using subsequent pregnancy and subsequent sterilization as the outcome measures. The final models include only those variables that remained significant.