Abstract
BackgroundWomen with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives.MethodsWe used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy.ResultsAt baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13).ConclusionsOur findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.
Highlights
The reproductive landscape for women living with HIV has changed significantly [1, 2], such that it is possible for women engaged in HIV care to become pregnant and have children with no risk of HIV transmission to their partners and an extremely low risk to future infants [3,4,5]
Pregnancy planning clinical guidelines exist to support healthcare providers in counselling women living with HIV about family planning and safe conception, discussions about pregnancy intentions between women and their healthcare providers are not routine and can be stigmatizing [15, 16]
Among women living with HIV of reproductive age in Canada, 60% have never discussed their reproductive goals with a healthcare provider since being diagnosed with HIV [17]
Summary
The reproductive landscape for women living with HIV has changed significantly [1, 2], such that it is possible for women engaged in HIV care to become pregnant and have children with no risk of HIV transmission to their partners and an extremely low risk to future infants [3,4,5]. Estimates of pregnancy intentions among women living with HIV in Canada are from cross-sectional studies prior to undetectable = untransmittable (U = U) messaging [13, 14]. They do not capture contemporary pregnancy intentions or their dynamic nature. Uptake of effective contraceptive methods among women living with HIV who report wanting to avoid pregnancy is low [18], and the range of contraceptive methods used is more narrow compared to HIV negative women [19], underscoring the need and opportunity to better understand and address the sexual and reproductive health needs of women living with HIV. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives
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