Background. The aim of this study was to determine current contraceptive use, contraceptive desires and knowledge, future fertility desires, and sterilization regret in a cohort of HIV-positive women. Study Design. 127 HIV-positive women receiving care at an urban infectious disease clinic completed a survey addressing their contraceptive and reproductive histories as well as their future contraceptive and fertility desires. Results. The most common forms of contraception used were sterilization (44.4%) and condoms (41.3%). Less than 1% used a long-term reversible method of contraception (LARC) despite these being the methods that best fit their desired attributes of a contraceptive method. Overall, 29.4% desired future fertility. Only 50.6% of those sexually active had spoken with a provider within the last year regarding their contraceptive plans. There was a high degree of sterilization regret (36.4%), and 18.2% of sterilized women desired future fertility. Multivariate analysis found women in a monogamous relationship had a statistically increased rate of regret compared to women who were not sexually active (OR 13.8, 95% CI 1.6–119, ). Conclusion. Given the diversity in contraceptive and fertility desires, coupled with a higher rate of sterilization regret than is seen in the general population, integration of comprehensive family planning services into HIV care via increased contraceptive education and access is imperative. 1. Introduction Since the mean desired fertility rate in the United States is 2 [1], American women spend most of their reproductive lives attempting to space or prevent pregnancies; however, nearly half of all pregnancies in the USA are unintended (unwanted or mistimed) [2]. Women at highest risk for unintended pregnancies are also at highest risk for HIV and sexually transmitted infection acquisition, including women of minority race, lower education level, and lower socioeconomic status [3]. Approximately 100,000 women of reproductive age in the USA are infected with HIV, and women of color disproportionately account for 80% of HIV-infected women [4]. The prognosis for people living with HIV has greatly improved and therefore the healthcare community is able to focus on quality-of-life issues rather than only length of life issues [5]. For example, the availability and use of highly active antiretroviral therapy (HAART) has dramatically reduced mother-to-child transmission and allowed HIV-positive women to live longer, healthier lives which in turn has affected their fertility desires [6, 7]. Cohort studies of HIV-positive
References
[1]
S. K. Henshaw, “Unintended pregnancy in the United States,” Family Planning Perspectives, vol. 30, no. 1, pp. 24–46, 1998.
[2]
L. B. Finer and S. K. Henshaw, “Disparities in rates of unintended pregnancy in the United States, 1994 and 2001,” Perspectives on Sexual and Reproductive Health, vol. 38, no. 2, pp. 90–96, 2006.
[3]
UNAIDS, “Report on the global AIDS epidemic: a UNAIDS 10th anniversary special edition: executive summary,” Joint United Nations Programme on HIV/AID, UNAIDS, Geneva, Switzerland, 2006.
[4]
ACOG Committee on Practice Bulletins–Gynecology, “ACOG Practice Bulletin No. 117: gynecologic care for women with human immunodeficiency virus,” Obstetrics and gynecology, vol. 116, no. 6, pp. 1492–1509, 2010.
[5]
H. Boonstra, “Meeting the sexual and reproductive health needs of people living with HIV,” Issues in Brief (Alan Guttmacher Institute), no. 6, pp. 1–4, 2006.
[6]
Centers for Disease Control and Prevention, “Epidemiology of HIV/AIDS—United States, 1981–2005,” Morbidity and Mortality Weekly Report, vol. 55, no. 21, pp. 589–592, 2006.
[7]
E. Z. Aaron and S. M. Criniti, “Preconception health care for HIV-infected women,” Topics in HIV Medicine, vol. 15, no. 4, pp. 137–141, 2007.
[8]
L. S. Massad, C. T. Evans, T. E. Wilson et al., “Contraceptive use among U.S. women with HIV,” Journal of Women's Health, vol. 16, no. 5, pp. 657–666, 2007.
[9]
N. L. Stanwood, S. E. Cohn, J. R. Heiser, and M. Pugliese, “Contraception and fertility plans in a cohort of HIV-positive women in care,” Contraception, vol. 75, no. 4, pp. 294–298, 2007.
[10]
W. D. Moshe and J. Jones, “Use of contraception in the United States: 1982–2008. National Center for Health Statistics,” Vital and Health Statistics, vol. 23, no. 29, 2010.
[11]
D. B. A. Clemetson, G. B. Moss, D. M. Willerford et al., “Detection of HIV DNA in cervical and vaginal secretions: prevalence and correlates among women in Nairobi, Kenya,” Journal of the American Medical Association, vol. 269, no. 22, pp. 2860–2864, 1993.
[12]
A. Kovacs, S. S. Wasserman, D. Burns et al., “Determinants of HIV-1 shedding in the genital tract of women,” Lancet, vol. 358, no. 9293, pp. 1593–1601, 2001.
[13]
C. C. Wang, R. S. McClelland, J. Overbaugh et al., “The effect of hormonal contraception on genital tract shedding of HIV-1,” AIDS, vol. 18, no. 2, pp. 205–209, 2004.
[14]
R. Heffron, D. Donnell, H. Rees et al., “Hormonal contraceptive use and risk of HIV-1 transmission: a prospective cohort analysis,” Lancet Infectious Diseases, vol. 12, pp. 19–26, 2012.
[15]
C. S. Morrison, B. A. Richardson, F. Mmiro et al., “Hormonal contraception and the risk of HIV acquisition,” AIDS, vol. 21, no. 1, pp. 85–95, 2007.
[16]
I. De Vincenzi, R. A. Ancelle-Park, J.-B. Brunet et al., “Comparison of female to male and male to female transmission of HIV in 563 stable couples,” British Medical Journal, vol. 304, no. 6830, pp. 809–813, 1992.
[17]
E. M. Stringer, M. Giganti, R. J. Carter, W. El-Sadr, E. J. Abrams, and J. S. A. Stringer, “Hormonal contraception and HIV disease progression: a multicountry cohort analysis of the MTCT-Plus Initiative,” AIDS, vol. 23, no. 1, supplement 1, pp. S69–S77, 2009.
[18]
K. M. Curtis, K. Nanda, and N. Kapp, “Safety of hormonal and intrauterine methods of contraception for women with HIV/AIDS: a systematic review,” AIDS, vol. 23, no. 1, pp. S55–S67, 2009.
[19]
“Hormonal contraception and HIV technical statement,” World health organization, 2012, http://whqlibdoc.who.int/hq/2012/WHO_RHR_12.08_eng.pdf.
[20]
“Panel on Antiretroviral Guidelines for Adults and Adolescents,” Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Bethesda (MD): Department of Health and Human Services; 2009, http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGl.pdf.
[21]
K. Nanda, E. Amaral, M. Hays, M. A. M. Viscola, N. Mehta, and L. Bahamondes, “Pharmacokinetic interactions between depot medroxyprogesterone acetate and combination antiretroviral therapy,” Fertility and Sterility, vol. 90, no. 4, pp. 965–971, 2008.
[22]
D. H. Watts, J. G. Park, S. E. Cohn et al., “Safety and tolerability of depot medroxyprogesterone acetate among HIV-infected women on antiretroviral therapy: ACTG A5093,” Contraception, vol. 77, no. 2, pp. 84–90, 2008.
[23]
R. A. Hatcher, J. Trussell, A. Nelson, W. Cates, D. Kowal, and M. Policar, Contraceptive Technology, Ardent Media, Atlanta, Ga, USA, 20th edition, 2011.
[24]
S. D. Hillis, P. A. Marcheanks, L. R. Tylor, and H. B. Peterson, “Poststerilization regret: findings from the United States collaborative review of sterilization,” Obstetrics and Gynecology, vol. 93, no. 6, pp. 889–895, 1999.
[25]
K. M. Curtis, A. P. Mohllajee, and H. B. Peterson, “Regret following female sterilization at a young age: a systematic review,” Contraception, vol. 73, no. 2, pp. 205–210, 2006.
[26]
D. Daley, “Reproductive health and AIDS-related services for women: how well are they integrated?” Family Planning Perspectives, vol. 26, no. 6, pp. 264–269, 1994.
[27]
W. Cates, Q. Abdool Karim, W. El-Sadr et al., “Global development. Family planning and the millennium development goals,” Science, vol. 329, no. 5999, p. 1603, 2010.
[28]
W. Cates Jr. and K. M. Stone, “Family planning, sexually transmitted diseases and contraceptive choice: a literature update. Part II,” Family Planning Perspectives, vol. 24, no. 3, pp. 122–128, 1992.
