Reproductive Choices and Decisions for Clients with HIV

pregnancy

pregnancychildbearing

childbearing

contraceptioncontraception

Pregnancy in Women with HIV

Positive developments: • ARV therapy improves health/longevity• PMTCT reduces vertical transmission• Wider availability of support and care services

• Does not accelerate disease

• One-third pass HIV to newborn during pregnancy, delivery, and breastfeeding

• Possible increased risk of stillbirth and low birth weight

Source: Saada, 2000; Tai, 2007; Brocklehurst, 1998.

Reasons Clients with HIV May Consider Pregnancy

• Intense desire to have children

• Pressure to have children

• Fear that older children may die

• Concern about infertility

• Reassured by PMTCT

• Optimism about ARV therapy

• Avoid generating suspicions

• Apprehension about disclosing status

Source: Preble, 2003.

Reasons Clients with HIV May Avoid Childbearing

• Similar concerns to women without HIV: – economic status– desired family size– ideal spacing

• Concerns about health and quality of life

• Fear of transmitting HIV

• Anxiety about leaving orphans

• Concerns about limited access to help

In Their Own Words …

I would be committing a great sin if I would have another child knowing this one is sick. I would be putting responsibility on other people and killing myself. – Woman on ART

People who are unable to have children find it difficult to lead happy lives. – Man on ART

When I am married I will have to have a baby because only I and my boyfriend are aware that I am HIV-positive and people will ask why am I not becoming pregnant in marriage. – Woman with HIV

The community questions a woman falling pregnant while she knew her HIV status.

– Woman with HIV

Access to Information/Services is Key

• Consider reproductive choices

• Plan for the future

• Avoid unintended pregnancy

• Time pregnancy when health is optimal

• Reduce HIV transmission to children

• Reduce transmission to partnersSource: Chen, 2001.

Many Women with HIV Want to Use FP

Source: King, 1995.

0

5

10

15

20

25

Before After

FP services offered

Pregnancyrate among

women with HIV in

Rwandan study

22%

9%

During this period, contraceptive use increased from 16% to 24%.

Choices for Clients with HIV

1. Fertility decision: desire pregnancy?

PregnancyPregnancy desireddesired

NoNo YesYes

2. Informed decision(s):contraceptive method? STI/HIV prevention?

Intended Intended pregnancypregnancy

PregnancyPregnancycounselingcounseling

ContraceptiveContraceptive counselingcounseling

Ongoing HIVOngoing HIVcounselingcounseling

Safe/effectiveSafe/effectivecontraceptioncontraception

3. Treatment decision(s): ARV therapy for self and partner? PMTCT?

PMTCTPMTCT servicesservices

NoNoYesYes

ARVARVtreatmenttreatment

NoNoYesYes

Adapted from: Cates, 2001.