High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe, Malawi: Implications for the Risk of HIV Acquisition

Maria A Keating,Gloria Hamela,Agnes Moses,William C Miller,Irving F Hoffman,Mina C Hosseinipour,Landon Myer

doi:10.1371/journal.pone.0039109

Maria A Keating, Gloria Hamela + Show 5 more

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https://doi.org/10.1371/journal.pone.0039109

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Abstract

BackgroundHIV incidence is higher among pregnant women than their non-pregnant counterparts in some sub-Saharan African settings. Our aims were (1) to estimate HIV incidence during pregnancy and (2) to compare sexual activity between pregnant, postpartum, and non-pregnant women.MethodsWe examined a retrospective cohort of 1087 women to identify seroconverters using antenatal and labor ward HIV test results. We also conducted a cross-sectional survey, including a quantitative questionnaire (n = 200) and in-depth interviews (n = 20) among women in early pregnancy, late pregnancy, postpartum, and non-pregnancy. Outcomes included measures of sexual activity, reported spouse’s risky behavior, and beliefs about abstinence.Results11 of 1087 women seroconverted during pregnancy yielding a 1% seroconversion risk and an incidence rate of 4.0/100 person years (95% CI 2.2–7.2). The reported sexual activity of the early pregnancy and non-pregnancy groups was similar, but significantly higher than the late pregnancy and postpartum groups (p<0.001). During pregnancy, sex acts decreased as gestation increased (p = 0.001). There was no reported difference in the spouse’s risky behavior. Most women believed that sex should cease between the 6th and 8th month of pregnancy and should not resume until 6 months postpartum. Some talked about conflict between their cultural obligation to abstain and fear of HIV infection if their spouses find other partners.ConclusionsHIV incidence is high among pregnant women in Malawi, and sexual activity decreases during pregnancy and postpartum. Pregnant women need to be informed of their increased risk for HIV and the importance of using condoms throughout pregnancy and the postpartum period.

Highlights

In some sub-Saharan African settings, HIV incidence is higher among pregnant women than their non-pregnant counterparts [1,2,3,4]
Sexual activity of the pregnant woman decreases during pregnancy and the postpartum period, but that decrease may lead to riskier behavior among male spouses [5,6,7,8,9]
In Malawi, primary prevention of HIV infection among women of child-bearing age is the first prong of national prevention of mother-to-child transmission (PMTCT) guidelines [11]

Summary

Introduction

In some sub-Saharan African settings, HIV incidence is higher among pregnant women than their non-pregnant counterparts [1,2,3,4]. In Malawi, primary prevention of HIV infection among women of child-bearing age is the first prong of national prevention of mother-to-child transmission (PMTCT) guidelines [11]. To achieve this goal, the factors that put pregnant and postpartum women at risk of HIV acquisition must be identified to ensure appropriate interventions are integrated into PMTCT programs. We sought to estimate HIV incidence during pregnancy and to describe sexual behavior among pregnant, postpartum, and non-pregnant women in Lilongwe, Malawi. Our aims were (1) to estimate HIV incidence during pregnancy and (2) to compare sexual activity between pregnant, postpartum, and non-pregnant women

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