Sexual Practices, Fertility Intentions, and Awareness to Prevent Mother-to-Child Transmission of HIV among Infected Pregnant Women at the Yaounde Central Hospital

INTRODUCTION:

The sexual and reproductive health of people living with HIV is fundamental for their well-being. Antiretroviral therapy and reproductive technologies have significantly improved quality of life of people living with HIV in developed countries. In sub-Saharan Africa, the epicenter of HIV, the sexual practices and fertility of women infected with HIV have been understudied.

AIM:

To assess the sexual behavior, fertility intentions, and awareness of preventing mother-to-child transmission of HIV in pregnant women with HIV-negative partners in Yaounde Central Hospital (Yaounde, Cameroon).

METHODS:

A cross-sectional survey using a semistructured, interviewer-administered questionnaire was conducted at the antenatal unit and HIV clinic in 2014.

MAIN OUTCOME MEASURES:

Ninety-four pregnant women infected with HIV provided consistent information on (i) sociodemographic characteristics, (ii) sexual and fertility patterns, (iii) awareness of preventing mother-to-child transmission of HIV, and (iv) their unmet needs.

RESULTS:

Although sexual desire had significantly changed since their HIV diagnosis, the women were highly sexually active. Approximately 19% of women had more than one sexual partner and 40% had regular unprotected sex during the 12-month period before the interviews (P < .0001). Twenty-nine percent of women preferred intermittent sexual intercourse and inconsistent condom use to delay pregnancy, but the abortion rate remained high. Age, marital status, and education affected women's awareness of mother-to-child transmission (P < .05); and no association existed between the number of living children and future pregnancies (r_s = -0.217; P = .036).

CONCLUSION:

HIV-infected women living with HIV-negative partners in Cameroon expressed high sexual and fertility intentions with several unmet needs, including safer sexual practices and conception. Incorporating and supporting safe sexual educational practices and conception services in maternal care can decrease risky sexual behavior and vertical transmission.

Full article at:   http://goo.gl/RE0oku

By:  Kuete M1, Yuan H2, He Q3, Tchoua Kemayou AL4, Ndognjem TP4, Yang F2, Hu Z2, Tian B2, Zhao K2, Zhang H2, Xiong C5.

• 1Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 2Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 3Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 4Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 5Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: clxiong951@sina.com. 
• Sex Med. 2016 Mar 19. pii: S2050-1161(16)00031-3. doi: 10.1016/j.esxm.2016.01.004.

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Contraceptive Practices and Fertility Desires among HIV-Infected and Uninfected Women in Kenya: Results From a Nationally Representative Study

Background

Prevention of unplanned pregnancies is a critical element in the prevention of mother-to-child transmission of HIV infection, but its potential has not been fully realized. We assessed the utilization of family planning (FP) and fertility desires among women of reproductive age by HIV status.

Methods

We selected a nationally representative sample of households using a stratified 2-stage cluster design and surveyed women aged 15–49 years. We administered questionnaires and examined predictors of current use of FP and desire for children among sexually active women with known HIV infection and women who were HIV uninfected.

Results

Of 3583 respondents, 68.2% were currently using FP, and 57.7% did not desire children in the future. Among women who did not desire children in the future, 70.9% reported that they were using FP, including 68.7% of women with known HIV infection and 71.0% of women who were HIV uninfected. Women with known HIV infection had similar odds of using FP as women with no HIV infection (odds ratio, 1.12; 95% confidence interval: 0.81 to 1.54). Women with no HIV infection had significantly higher adjusted odds of desiring future children (adjusted OR, 2.27; 95% confidence interval: 1.31 to 3.93) than women with known HIV infection.

Conclusions

There is unmet need for FP for HIV-infected women, underscoring a gap in the national prevention of mother-to-child transmission of HIV strategy. Efforts to empower HIV-infected women to prevent unintended pregnancies should lead to expanded access to contraceptive methods and take into account women’s reproductive intentions.

Full article at:   http://goo.gl/oY8118

By:  Evelyn W. Ngugi, MBChB, MPH,* Andrea A. Kim, PhD, MPH,* Raymond Nyoka, MSc,* Lucy Ng’ang’a, MBChB, MPH,*Irene Mukui, MBChB,† Bernadette Ng’eno, MBChB, MMed,* and George W. Rutherford, MD, AM‡, for the KAIS Study Group

^*Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya

^†National AIDS and Sexually Transmitted Infection (STI) Control Programme, Ministry of Health, Nairobi, Kenya

^‡Global Health Sciences, University of California, San Francisco, San Francisco, CA

Correspondence to: Evelyn W. Ngugi, MBChB, Division of Global HIV/AIDS, Center for Global Health, US Centers for Disease Control and Prevention, PO Box 606-00621, Village Market, Nairobi, Kenya

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Determinants of Desire for Children among HIV-Positive Women in the Afar Region, Ethiopia: Case Control Study

Introduction

The desire for a child in Ethiopian society is normal. Among HIV positive women, due to the risk of MTCT, it is imperative to understand factors influencing women’s desire for children. This study aimed at assessing factors associated with desire for children among HIV-positive women in two selected hospitals of Afar Regional State, Ethiopia.

Methods

A facility based case-control study was conducted among 157 cases (with a desire) and 157 controls of HIV positive individuals registered in the selected health facilities. The participants were selected by random sampling technique. Data were collected using face-to-face interview and was analyzed using logistic regression.

Result

Factors found to be independently associated with desire for children were age categories of 20–24 years (OR = 6.22, 1.29–10.87) and 25–29 years (OR = 14.6, 3.05–21.60), being married (OR = 5.51, 2.19–13.54), Afar ethnicity (OR 6.93, 1.19–12.14), having HIV-positive children (OR 0.23, 0.09–0.63), duration on ART more than one year (3.51, 1.68–9.05), CD4 count greater than 350 (OR 4.83, 1.51–7.27) and discussion of reproductive health issues with health providers (OR 0.31, 0.12–0.51).

Conclusion

Women who were young, married, Afar, those who received ART more than one year, and had CD4 count >350 were more likely to have a desire for children.

Below:  Factors independently associated with desire for children among cases and controls of HIV positive women on ART Afar region, Ethiopia, 2012

Full article at:   http://goo.gl/5iQNRR

By:  Fatimetu Mohammed, Nega Assefa 

College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia

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Are Pregnancy Intentions Associated with Transitions Into and Out of Marriage?

CONTEXT:

In addition to having associations with health outcomes, pregnancy intentions may be associated with social outcomes, including marital transitions.

METHODS:

Linked data from the 2004-2008 Oklahoma Pregnancy Risk Assessment Monitoring System and The Oklahoma Toddler Survey for 2006-2010 on 3,617 women who were married and 2,123 who were unmarried at conception were used to examine the relationship between pregnancy intention status (intended, mistimed by less than two years, mistimed by two or more years, or unwanted) and marital formation or dissolution by the time of the birth and two years later. Logistic regression analyses were conducted, and propensity score methods were used to adjust for confounding characteristics.

RESULTS:

Intention status was associated with marital transition two years after the birth, but not between conception and birth. In adjusted models, among women married at conception, those with a birth resulting from an unwanted pregnancy were more likely than those with a birth resulting from an intended pregnancy to transition out of marriage by the time their child was two years old (odds ratio, 2.2). Among women unmarried at conception, those with a birth following an unwanted pregnancy were less likely than those with a birth following an intended pregnancy to marry by the time their child was two (0.5). Births following mistimed pregnancies were not associated with marital transition.

CONCLUSIONS:

The findings should motivate researchers to broaden the scope of research on the consequences of unintended childbearing. Future research should distinguish between mistimed and unwanted births.

Purchase full article at:   http://goo.gl/k6tgQH

By:  Maddow-Zimet I1, Lindberg L2, Kost K2, Lincoln A3.

• 1Guttmacher Institute, New York. imaddowzimet@guttmacher.org.
• 2Guttmacher Institute, New York.
• 3Oklahoma Department of Health, Oklahoma City. 
• Perspect Sex Reprod Health. 2016 Feb 29. doi: 10.1363/48e8116.

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Sexuality and Reproduction in HIV-Positive Women: A Meta-Synthesis

The increased access to effective antiretroviral treatment (ART) has made HIV comparable to a chronic disease in terms of life expectancy. Needs related to sexuality and reproduction are central to overall health and well-being. An interpretative meta-synthesis was performed to synthesize and assess how HIV-positive women's experiences of sexuality and reproduction have been described in qualitative studies. A total of 18 peer-reviewed qualitative studies were included, which comprised a total of 588 HIV-positive interviewed women. The studies originated from resource-rich countries outside the Asian and African continents. The analysis, resulting in a lines-of-argument synthesis, shows that HIV infection was a burden in relation to sexuality and reproduction. The weight of the burden could be heavier or lighter. Conditions making the HIV burden heavier were: HIV as a barrier, feelings of fear and loss, whereas motherhood, spiritual beliefs, and supportive relationships made the HIV burden lighter. The findings are important in developing optimal health care by addressing conditions making the burden of HIV infection lighter to bear. In future research there is a need to focus not only on examining how HIV-positive women's sexual and relationships manifest themselves, but also on how health care professionals should provide adequate support to the women in relation to sexuality and reproduction.

...Ah, it's just always in the bedroom, HIV. It's always there^33, p.7

...In holistic care, it is important for health care professionals to see the women as whole individuals and not only focus on the disease. The result emphasizes the strength of support from health care professionals. But support is not only offering information; support is also about listening. There were narratives in the included studies of experiences of violence, which the women might need help to handle. As health care professionals, we have to ask and be open to stories of, for example, rape, or abuse. Supporting self-acceptance and awareness are only a few of the many areas where care providers outside the medical context can be important for patients' ongoing well-being.⁸ The importance of support from other HIV-positive women is emphasized in the meta-synthesis.^{20,22,30,34,36} Even though it is difficult for some women to attend support meetings like this, as it means they have to disclose their HIV-positive status, it is important to motivate women to meet other HIV-positive persons.

...There is a need for practical information about contraceptives, medical risks, and interventions related to the risk of HIV transmission and barriers between fertility intentions, and pregnancy seeking behavior also need to be illuminated.⁶⁵ Women actively trying to conceive intend not to talk with their provider about safer conception strategies and they expressed confusion and concern on how to conceive safely.⁶⁶ Reproductive counseling initiated by health care providers is needed to reduce risk of transmission to partners and infants, which can have major health implications.⁶⁶

Disclosure of HIV-positive status seems problematic, and some women may need the presence of a health care professional when the disclosure is made.⁶⁷ Everything has to be done without judgment; it is important for health care professionals not to relate to their personal sexual behaviors as the sexual norm.

In clinical practice, it might be of importance to address all these conditions that make the burden easier, to support pregnancy, to support the desires of these women, and to help them cope with negative feelings, in order to promote the sexual and reproductive health of HIV-positive women.

Full article at:   http://goo.gl/ZjBwDF

By:  Ewa Carlsson-Lalloo, RN, MHCSci,*1,,2 Marie Rusner, RN, MSc, PhD,1,,3 Åsa Mellgren, MD, PhD,2,,3 and Marie Berg, RN, RM, MNSci, MPH, PhD1,,4

¹Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden.

²Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden.

³Department of Research, Södra Älvsborg Hospital, Borås, Sweden.

⁴Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.

*Corresponding author.

Address correspondence to:, Ms. Ewa Carlsson-Lalloo, Institute of Health and Care Sciences, Box 457, University of Gothenburg, 405 30 Gothenburg, Sweden,
E-mail:  es.ug@oollal.nosslrac.awe

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Lights and Shadows about the Effectiveness of IVF in HIV Infected Women: A Systematic Review

Background. 

HIV infected women have higher rates of infertility. 

Objective. 

The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women. 

Materials and Methods. 

A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner. 

Results and Discussion. 

Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR) was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. 

Conclusion. 

Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.

Purchase full article at:   http://goo.gl/uOJEbS

By:  Marques C1, Guerreiro C2, Soares SR3.

• 1Maternidade Dr. Alfredo da Costa, Rua Viriato, 1069-089 Lisboa, Portugal.
• 2Fetal Maternal Department, Maternidade Dr. Alfredo da Costa, Lisbon, Portugal.
• 3Instituto Valenciano de Infertilidade (IVI-Lisboa), Lisbon, Portugal. 
• Infect Dis Obstet Gynecol. 2015;2015:517208. doi: 10.1155/2015/517208. Epub 2015 Dec 8.

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Women Infected with HIV Type 1 Have Poorer Assisted Reproduction Outcomes

OBJECTIVE:

To compare the efficacy of assisted reproductive technology (ART) in women infected with human immunodeficiency virus type 1 (HIV-1) versus HIV-negative controls.

INTERVENTION(S):

Ovarian stimulation, oocytes retrieval, standard in vitro fertilization (IVF) or intracytoplasmic sperm injection, embryo transfer.

MAIN OUTCOME MEASURE(S):

Clinical pregnancies and live-birth rates.

RESULT(S):

After oocyte retrieval, all women infected with HIV-1 infected were matched 1:1 to HIV-negative controls according to the following criteria: date of ART attempt, age, parity, main cause of infertility, ART technique, and rank of attempt. Only the first IVF cycle during the study period was considered for each couple. We found no statistically significant differences between the two groups for ovarian stimulation data, fertilization rate, or average number of embryos transferred. The clinical pregnancy rate per transfer was statistically significantly lower for the cases compared with the controls (12% vs. 32%), as were the implantation rate (10% vs. 21%) and the live-birth rate (7% vs. 19%).

CONCLUSION(S):

In one of the largest studies to pair six factors that influence the results of ART, HIV infection in women was associated with poorer outcomes after ART. These results suggest that women with controlled HIV-1-infection should be counseled not to delay ART in cases of self-insemination failure or other causes of infertility. Fertility preservation by vitrification of oocytes in women whose pregnancy should be delayed may be an important future consideration.

Purchase full article at:   http://goo.gl/KD6yWD

By:  Stora C1, Epelboin S2, Devouche E1, Matheron S1, Epelboin L1, Yazbeck C1, Damond F1, Longuet P1, Dzineku F1, Rajguru M1, Delaroche L1, Mandelbrot L1,Luton D1, Patrat C1.

• 1Centre d'Assistance Médicale à la Procréation, Service de Gynécologie-Obstétrique, Hôpital Bichat-Claude Bernard, Paris, France.
• 2Centre d'Assistance Médicale à la Procréation, Service de Gynécologie-Obstétrique, Hôpital Bichat-Claude Bernard, Paris, France. Electronic address: sylvie.epelboin@aphp.fr.
• Fertil Steril. 2016 Jan 19. pii: S0015-0282(16)00004-2. doi: 10.1016/j.fertnstert.2015.12.138. 

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Level, Trend & Correlates of Mistimed & Unwanted Pregnancies among Currently Pregnant Ever Married Women in India

Unintended pregnancy accounts for more than 40% of the total pregnancies worldwide. An Unintended pregnancy can have serious implications on women and their families. With more than one-fourth of the children in India born out of unintended pregnancies such pregnancies are considered to be one of the major public health concerns today. 

The present study is aimed at determining major predictors of unintended pregnancy among currently pregnant ever-married women in India. The present study has used National Family Health Survey (NFHS) data, conducted by the International Institute for Population Sciences (IIPS), Mumbai, to show the trend, pattern and determinants of mistimed and unwanted pregnancies. Bivariate and multinomial logistic regression model have been used with the help of Stata 13 software. 

The results show that the likelihood of a mistimed pregnancy is more prevalent among young women whereas the prevalence of unwanted pregnancy is observed more among the women aged 35 years or more. The results also show that the risk of experiencing mistimed pregnancy decreases if the woman belongs to 'other' castes and has higher education. The likelihood of unwanted pregnancy decreases among married women aged 18 years and above, those women having higher education, some autonomy and access to any mode of mass communication. 

Knowledge of these predictors of mistimed and unwanted pregnancy will be helpful in identifying the most vulnerable group and prioritize the intervention strategies of the reproductive health programmes for the population in need.

Below:  Trend of pregnancy intention among currently pregnant married women

Full article at:  http://goo.gl/TCAeuR

By:  Dutta M1, Shekhar C1, Prashad L2.

• 1Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India.
• 2School of Social Sciences, Tata Institute of Social Sciences, Mumbai, India. 

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Fertility Desires, Family Planning Use & Pregnancy Experience: Longitudinal Examination of Urban Areas in Three African Countries

Many women have inconsistent fertility desires and contraceptive use behaviors. This increases their risk of unintended pregnancies. Inconsistencies may reflect barriers to family planning (FP) use but may also reflect ambivalence toward future childbearing. Using urban data from Kenya, Nigeria, and Senegal, this study examines the role of fertility desires and FP use behaviors on pregnancy experience over a 2-year follow-up period.

Data come from baseline and 2-year follow-up among urban women interviewed in Kenya, Nigeria, and Senegal. At baseline (2010/2011), women were asked about their future fertility desires (want child soon, want to delay >2 years, does not want) and current FP use. At midterm (2012/2013), women were asked if they were currently pregnant or had a birth in the 2-year period. We examine the association between baseline fertility desires and FP use with pregnancy experience and desirability of an experienced pregnancy.

In the 2-year follow-up period, 27–39 % of women in union experienced a pregnancy or birth. In Kenya and Nigeria, 30–35 % of women using a modern FP method experienced a pregnancy/birth; the percentage with a pregnancy/birth was slightly higher among women not using at baseline (41 % in both countries). In Senegal, the distinction between pregnancy experience between users and non-users was greater (16 % vs. 31 %, respectively). In all countries, pregnancy was less common among users of long-acting and permanent methods; only a small percentage of women use these methods. Women not wanting any(more) children were the least likely to experience a pregnancy in the 2-year follow-up period. No differences were observed between those who wanted to delay and those who wanted soon. Multivariate findings demonstrate distinctions in pregnancy experience by fertility desires among modern FP users. Non-users have similar pregnancy experience by fertility desires.

Fertility desires are not stable; providers need to consider the fluidity of fertility desires in counseling clients. Programs focusing on new FP users may miss women who are the most motivated to avoid a pregnancy and need to switch to a more effective method; this will result in less unintended pregnancies overall.

Full article at:  http://goo.gl/FeS6Xz

By:  Ilene S. Speizer^12* and Peter Lance²

¹Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

²Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA

 

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