Abstract
BackgroundImprovements in life expectancy and quality of life for HIV-positive women coupled with reduced vertical transmission will likely lead numerous HIV-positive women to consider becoming pregnant. In order to clarify the demand, and aid with appropriate health services planning for this population, our study aims to assess the fertility desires and intentions of HIV-positive women of reproductive age living in Ontario, Canada.Methodology/Principal FindingsA cross-sectional study with recruitment stratified to match the geographic distribution of HIV-positive women of reproductive age (18–52) living in Ontario was carried out. Women were recruited from 38 sites between October 2007 and April 2009 and invited to complete a 189-item self-administered survey entitled “The HIV Pregnancy Planning Questionnaire” designed to assess fertility desires, intentions and actions. Logistic regression models were fit to calculate unadjusted and adjusted odds ratios of significant predictors of fertility intentions. The median age of the 490 participating HIV-positive women was 38 (IQR, 32–43) and 61%, 52%, 47% and 74% were born outside of Canada, living in Toronto, of African ethnicity and currently on antiretroviral therapy, respectively. Of total respondents, 69% (95% CI, 64%–73%) desired to give birth and 57% (95% CI, 53%–62%) intended to give birth in the future. In the multivariable model, the significant predictors of fertility intentions were: younger age (age<40) (p<0.0001), African ethnicity (p<0.0001), living in Toronto (p = 0.002), and a lower number of lifetime births (p = 0.02).Conclusions/SignificanceThe proportions of HIV-positive women of reproductive age living in Ontario desiring and intending pregnancy were higher than reported in earlier North American studies. Proportions were more similar to those reported from African populations. Healthcare providers and policy makers need to consider increasing services and support for pregnancy planning for HIV-positive women. This may be particularly significant in jurisdictions with high levels of African immigration.
Highlights
Indisputable health improvements have occurred with the advent of antiretroviral therapy (ART) over the last 15 years, resulting in dramatic reductions in HIV-related morbidity and mortality and yielded improvements in quality of life [1].Breakthroughs in pregnancy care have reduced the risk of vertical transmission to,1% if pregnant women receive timely ART, achieve optimal viral suppression, deliver by caesarean-section when appropriate, and avoid breastfeeding [2]
61% were born outside of Canada, 52% were living in Toronto, 47% defined themselves as being of African ethnicity and 74% were currently on ART
An HIVpositive woman in her 20 s or 30 s, of African descent, living in Toronto, who had already given birth to no more than one child, would be most likely to intend to become pregnant (Figure 2). In this cross-sectional study of 490 HIV-positive women of reproductive age living in Ontario, Canada, we found that 69% desire and 58% intend to become pregnant in the future
Summary
Indisputable health improvements have occurred with the advent of antiretroviral therapy (ART) over the last 15 years, resulting in dramatic reductions in HIV-related morbidity and mortality and yielded improvements in quality of life [1]. Over 80% of HIV-positive women are of reproductive age [4] This combination of factors suggests that many HIV-positive women may desire to become pregnant and that pregnancy planning will become an increasingly important component of HIV medicine. Due to Ontario’s openness to immigration and the large community of African refugees, population-based observational HIV studies carried out in Ontario can provide important insights relevant to similar centres worldwide. This cross-sectional study was designed to gather information about the fertility desires, intentions and actions of HIV-positive women, and to identify predictors of fertility intentions. By collecting information from women of reproductive age in communities across Ontario, we hope to aid healthcare providers and policy makers in identifying gaps and in planning for needed services
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