The Year-Long Effect of HIV-Positive Test Results on Pregnancy Intentions, Contraceptive Use, and Pregnancy Incidence Among Malawian Women

• DOI: 10.1097/qai.0b013e318165dc52
• Publication Date: 2009-03-05T15:35:29Z
• Authors: Irving F Hoffman; Francis E A Marti...; Kimberly A Powers; David A Chilongozi; Emmie D Msiska; Emma I Kachipapa; Chimwemwe D Mphande; Mina C Hosseinipour; Harriet C Chanza; Rob Stephenson; Amy O Tsui
• Keywords: Adult; Counseling; Malawi; Time Factors; Anti-HIV Agents; HIV Infections; Pregnancy, Unwanted; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Contraceptive Agents; 5. Gender equality; Pregnancy; Family Planning Services; Surveys and Questionnaires; HIV Seropositivity; Humans; Female; Prospective Studies; Pregnancy Complications, Infectious

To estimate the effect of receiving HIV-positive test results on intentions to have future children and on contraceptive use and to assess the association between pregnancy intentions and pregnancy incidence among HIV-positive women in Malawi.Women of unknown HIV status completed a questionnaire about pregnancy intentions and contraceptive use and then received HIV voluntary counseling and testing (VCT). Women who were HIV-positive and not pregnant were enrolled and followed for 1 year while receiving HIV care and access to family planning (FP) services.Before receiving their HIV test results, 33% of women reported a desire to have future children; this declined to 15% 1 week later (P < 0.0001) and remained constant throughout follow-up. Contraceptive use increased from 38% before HIV testing to 52% 1 week later (P < 0.0001) and then decreased to 46% by 12 months. The pregnancy incidence among women not reporting a desire to have future children after VCT was less than half of the incidence among women reporting this desire.With knowledge of their HIV-positive status, women were less likely to desire future pregnancies. Pregnancy incidence was lower among women not desiring future children. Integration of VCT, FP, and HIV care could prevent mother-to-child HIV transmission.