• 21
    Nov
  • Reproductive Decision-Making among HIV-infected Women: RESULTS

Description of Sample

Table 1 shows a description of the sample. Women were predominantly African-American, single and had a mean age at diagnosis of 25 years (SD 5.9, range 14.0-38.1). Forty-one percent had less than a high-school education, half the sample had an income of <$6,000 a year and a third were employed at the time of diagnosis. The majority were Baptist and described themselves as being “somewhat religious.” Almost two-thirds of the women were diagnosed with HIV (treating HIV infection) between the years 1986 and 1992. The rest were diagnosed between 1993 and 1996. Women were relatively healthy at diagnosis, with almost half having a first available CD4 count of >500. The predominant mode of HIV transmission was through heterosexual contact, followed by IV drug use. Most women reported never drinking alcohol or drinking only a few times a month or less. Forty-three percent said they had ever used a nonin-jecting drug at any time in their life. Among these, almost half had last used over a year ago. Over the course of the study period, 37% of the sample had a live birth, 13% experienced a pregnancy loss, 5% had an elective abortion, and almost half had a surgical sterilization subsequent to their HIV (Viramune canadian belongs to a class of HIV drugs) diagnosis.

Table 1. Description of sample (N=104)

Characteristic

N

%

Characteristic

N

%

Race Year of HIV Diagnosis
African-American

82

79

1986-1992

65

63

White

20

19

1993-1996

39

38

Other

2

2

CD4 Count at Entry
Marital Status <200

9

9

Single

67

64

200-499

45

44

Married

12

12

500+

48

47

Separated/divorced/widowed

22

24

Mode of Transmission
Age at diagnosis (mean years, SD) 24.7 5.9 Heterosexual contact IV drug use 72 25 69 24
Education Blood

6

6

Less than high school

43

41

Unknown

1

1

Completed high school

34

33

Some college/completed college

27

26

Current Alcohol UseA few times a week or more

10

10

Income A few times a month or less

46

44

<$6/000/year

51

50

Never

48

46

$6,000-$ 17,999/year

37

36

>$18,000/year

15

15

Noninjecting Drug use Recent (past year)

22

21

Employed

35

34

Past (over a year ago) Never 23 59 22 57
Religion
Baptist

73

70

Reproductive History
Other Protestant

3

3

Live birth subsequent to HIV diagnosis

38

37

Catholic

16

15

Pregnancy loss subsequent to HIV diagnosis 13

13

Other/none

12

12

Abortion subsequent to HIV diagnosis Sterilization subsequent to HIV diagnosis 5 46 5 44
Religiosity
Not at all religious

7

7

Somewhat religious

64

62

SD: Standard Deviation, IV: Intravenous
Very religious

33

32

Table 2 describes relationship characteristics, emotional support and desire for children among the women in the sample. Over half the women were in a relation­ship at the time of the interview with a mean of 4.7 years (SD 3.7, range 0.08-18.0) in the relationship. Among these, almost two-thirds had a partner who was HIV-negative, and the majority of women’s partners knew of their HIV (Zerit tablet treating HIV infection) status. Just over half of women’s partners wanted to have more children at the time of the interview. When asked about their current source of emotional support, partners and mothers were cited the most frequently, followed by self or no one. Of the over 200 children born to women in the sample over the course of the study period, only 8% were infected with HIV (Retrovir medication was the first drug approved for the treatment of HIV) and 4% had died (though only one had died due to HIV-related causes). Prior to diagnosis, 57% of the women reported that they had wanted more children, but only 36% said they currently wanted any more children.

Table 2. Relationships, emotional support and desire for children (N=104)

Characteristic

N

%

Currently in a relationship

55

53

Number of years in relationship with current partner among those currently in a relationship
(N=53) (mean years, SD) 4.7 3.7
Current Partner’s HIV Status (N=54)
Positive

14

26

Negative

35

65

Unknown

5

9

Current Partner’s Knowledge of Subject’s HIV Status (N=54)
Knows

47

87

Doesn’t know

7

13

Current partner desires more children (among women with a current partner, N=43)

22

51

Current Source of Emotional Support
Partner

23

22

Mother

23

22

Self/no one

19

18

Other family

14

14

Friend (s) CO

8

Lord

7

7

Child

4

4

Medical worker

4

4

Support groups

2

CN
Number of HIV-positive children (N=203 children)

16

8

Number of children who have died (N=211 children)

8

4

Desired more children before diagnosis0 Currently desires more childrend

40

57

34

36

c: N=70; d: N=94 (reduced N due to late addition to questionnaire); SD: standard deviation

Pregnancy

Pregnant women (cases only) were also asked to discuss the circumstances of their pregnancies. Among the women who had a subsequent pregnancy, 55% said they had tried to prevent their first subsequent pregnancy, 12% said they had planned to get pregnant, and 33% said they had neither planned to get pregnant nor used contraception. In other words, 88% of these first subsequent pregnancies were unplanned.

Women who did not have a subsequent pregnancy were asked to discuss the circumstances sur rounding their reasons for not getting pregnant. A third of these women had wanted to get pregnant since their diagnosis, and 11% had actually tried to get pregnant. However, fully 83% said that they had made a conscious decision not to get pregnant, even though they may have wanted to. Sixty-three percent said their HIV (treating HIV infection) diagnosis greatly affected their decision. Over half the sample (56%) reported that they would have tried to get pregnant if they had not been HIV-positive.

Table 3. Bivariate characteristics (%) of women who became pregnant or had a surgical sterilization since HIV diagnosis

Pregnant (n=44)a Nonpregnant (n=60) Sterilized (n=46) Nonsterilized (n=58)
Race/Ethnicity

African-American

86

73

76

81

White

11

25

24

16

Other

2

2

0

3

Marital Status

Nonmarried

98*

82

89

88

Married

2

18

11

12

Age [Years (SD)]

23 (5.4)*

26 (5.9)

24 (4.8)

25 (6.6)

Less than high-school education

52.3f

33.3

41.3

41.4

Income

<$6,000/year

55

46

51

48

$6,000-$ 17,999/year

34

37

36

36

>$18,000/year

11

17

13

16

Employed

36

32 44t 26
Religion

Baptist

73

68

80*

62

Other

27

32

20

38
Religiosity

Not at all/somewhat religious

75*

63

76

62

Very religious

25

37

24

38
Year of HIV Diagnosis

1986-1992

77*

52

67

59

1993-1996

23

48

33

41
CD4 Count, First Available

<200

2*

14 0*b 16

200-499

40

48

48

41

500+

58

39

52

43
Current Alcohol Use

Every or nearly every day

7

12

13

7

A few times a month or less

46

28

41

31

Never

48

60

46

62
Non-IV Drug Use

Recent (past year)

34*

12

24

19

Past (over a year ago)

16

27

22

22

Never

50

62

54

59

Live birth subsequent to HIV diagnosis

48*

28

Currently desires more children

29

41

30

42

Current partner desires more children0

47

54

32*

71

Current partner HIV-positive

9

17

20

9
** p<0.005; * p<0.05; f p<0.1; a: Frequencies may vary due to missing values in some variables; b: Fisher’s exact test; c: Among those
with a partner; SD: standard deviation; IV: intravenous

Comparisons of women who had a pregnancy subsequent to learning their HIV (treating HIV infection) diagnosis with those who did not showed that pregnant women are predominantly unmarried, younger and have less than a high-school education compared to nonpregnant women (Table 3). Women who became pregnant were more likely to report being not at all or only somewhat religious. Pregnant women were also more likely to have been diagnosed earlier in the epidemic and to be healthier in terms of CD4 counts than nonpregnant women. Women who had a subsequent pregnancy were also more likely to have a recent history (within the past year) of noninjecting drug use. Pregnant and nonpregnant women did not differ significantly on whether they or their current partners wanted more children or on their partners’ HIV status.

A multivariate model was constructed using forward logistic regression to predict subsequent pregnancy (Table 4). All variables that had significant bivariate associations were included: age, marital status, year of HIV diagnosis, noninjecting drug use, CD4 count, education and religiosity. Age was protective, as increasing age reduced the odds of subsequent pregnancy. However, single women were 11.5 times as likely to have a subsequent pregnancy as nonsingle women, women diagnosed earlier in the epidemic were 3.5 times as likely to have a subsequent pregnancy as women diagnosed after 1993, and recent users of non-IV drugs were 6.6 times as likely to have a subsequent pregnancy as women who did not have recent drug use.

Table 4. Logistic regression model predicting pregnancy (n=104)*

OR

95% CI

P Value

Age at diagnosis

0.89

0.82-0.97

0.01

Single

11.54

1.32-100.6

0.03

HIV diagnosis 1986-1992

3.49

1.30-9.36

0.01

Recent non-IV drug use

6.6

1.87-23.32

0.00

Hosmer-Lemeshow Goodness of Fit

0.49

OR: odds ratio; CI: confidence interval; IV: intravenous; * Model controlled for education, CD4 count and religiosity

Sterilization

Women who underwent a subsequent sterilization procedure were asked about their reasons for doing so. The majority of women (63%) stated that their HIV diagnosis influenced them a lot in their decision; 41% reported that they would have gotten sterilized even if they had not been infected.

Comparisons of women who had a surgical sterilization subsequent to learning their HIV diagnosis with those who did not showed that sterilized women are more likely to be employed, Baptist and have higher initial CD4 counts than nonsterilized women (Table 3). They were also less likely to be with a partner who desires a child (among those with a partner) and more likely to have already had a live birth subsequent to their HIV diagnosis.
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Table 5. Logistic regression model predicting sterilization (N=104)*

OR

95% CI

P Value
Baptist                                                        2.59 Subsequent live birth                                    2.47 Hosmer-Lemeshow Goodness of Fit 1.03-6.51 1.07-5.70 0.91

0.04 0.03

OR: odds ratio; CI: confidence interval; * Model controlled for CD4 count and employment

A multivariate model was constructed using forward logistic regression to predict subsequent sterilization (Table 5). All variables that had significant bivariate associations were included: employment status, CD4 count, religion, subsequent live birth and being with a partner who desires more children. Women who were Baptist were 2.6 times as likely to have undergone a sterilization procedure after learning their HIV diagnosis, and women who had had a live birth subsequent to their HIV diagnosis were 2.5 times as likely to have undergone a sterilization procedure after learning their HIV diagnosis.

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