Study Finds Gaps in Pregnancy Counseling for HIV-Positive Women


More than half of HIV-positive women who wish to have children have not received adequate pregnancy counseling from their health care providers, according to a study published in the May 20 issue of AIDS Patient Care and STDs.

According to HIV/AIDS Treatment News, “A lack of counseling can negatively women of childbearing years, along with their sexual partners and children, should they decide to conceive or go forward with an unintended pregnancy.”

Many of these women receive inadequate counseling which prevents them from being informed about risks that may be incurred during pregnancy and delivery. With the right resources and adequate information, many women’s and children’s lives could be saved.

According to HIV/AIDS Treatment News,

“Women who have undetectable viral loads are significantly less likely to pass their virus on to their HIV-negative sex partners, either during sexual intercourse or in conjunction with assistive reproductive technologies, such as “sperm washing” and in vitro fertilization.”

With the right questions being asked and the provider giving accurate information the women could make informed decisions about anti-retroviral therapy before they concieve and during delivery.

HIV/AIDS Treatment News notes that:

“To find out what sort of conversations were being discussed among providers and the HIV-Postive Women, Sarah Finocchario-Kessler, PhD, MPH, from the Johns Hopkins Bloomberg School of Public Health in Baltimore and her colleagues conducted computer-assisted interviews with 191 HIV-positive women being seen at one of two Baltimore HIV clinics. Most of the women were African American, and their average age was 32. Only 28 percent reported consistently using condoms with their sex partners, either to prevent HIV transmission or prevent pregnancy. Most of the women—66 percent—reported that they intended to have a child in the future.”

Finocchario-Kessler found that younger women in the study had more personalized discussions with their providers, compared to 56 percent of older women who had not had a personalized discussion about their pregnancy with providers. Many HIV-Positive women who wanted to discuss the issue of HIV and their pregnancy had to initiate the conversation themselves.

Still, the authors note that their findings can not be generalized to all women or HIV care settings because their patients were attending a top urban HIV specialty clinic, which represents the best case scenario.

So for women who do not have state-of-the-art facilitates with limited resources the outcome could be different. The authors also believe that providers trained in dealing with HIV will feel more comfortable discussing the topic with patients, but regular physicians have been known to feel uncomfortable discussing HIV in regard to planned pregnancies.

“Given the stigma HIV-infected women may experience when considering childbearing, they may have a heightened fear of disapproval from their HIV provider,” the authors state. “If communication is not initiated by the provider, it may only occur after pregnancy.”

Thirty-nine percent of women in the study had an undetectable viral load at the time of the interview, so the lack of discussion of these issues with providers might imply higher risks for HIV-Negative partners and in planned pregnancies.

“Universal communication about future reproductive desires and intentions,” the authors conclude, “can reduce missed opportunities to offer guidance to those with childbearing interests, help reduce stigma by normalizing childbearing among women living with HIV, and assist women to avoid unintended pregnancies.”

This is a particularly important finding for women in communities known to have less access overall to primary reproductive and sexual health care.  According to the Center for Disease Control:

“Of the 126,964 women living with HIV/AIDS, 64% were black, 19% were white, 15% were Hispanic, 1% were Asian or Pacific Islander, and less than 1% were American Indian or Alaska Native.”

With the new information, hopefully providers can learn to initiate conversation with HIV-positive patients and make sure they have the most accurate information and feel comfortable discussing their situation.  We need to make sure we reduce the stigmas of HIV/AIDs and make sure we take advantage of opportunities to make sure women’s reproductive needs are met before its too late.

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