Among reproductive-age, HIV-positive women in the United States, unplanned pregnancies are prevalent, according to a recently published study in Plos One. Use of highly effective long-acting reversible contraceptives (LARC) in this population is also low.
Among women living with diagnosed HIV infection in the United States, 64.7% are of reproductive age (aged 18 to 44 years), and heterosexual activity remains the primary mode of HIV transmission. However, unplanned pregnancies and contraceptive use among HIV-positive women have been understudied.
Using 2013 to 2014 data from the Medical Monitoring Project, an HIV surveillance system that produces national estimates for HIV-positive adults receiving care, researchers examined unplanned pregnancies and contraceptive use among HIV-positive women in a cross-sectional study.
Women were included for data analysis if they had received HIV care and were diagnosed with HIV before 45 years of age. Adjusted prevalence ratios (aPR) of unplanned pregnancies were calculated.
Additionally, for women who were age 18 to 44 years at the time of interview, weighted prevalence of contraceptive use (previous 12 months) by method was computed, including permanent (sterilization), short-acting (pills, depo-progesterone acetate), LARC (implants), and barrier (condoms) contraception.
Of 671 participants, one or more unplanted pregnancies were reported in 78.1% of women. Women who were reporting unplanned pregnancies were more likely to be non-Hispanic white (aPR, 1.20; CI, 1.05-1.38) or non-Hispanic black (aPR, 1.14; CI, 1.01-1.28) than Hispanic, to be above the poverty level (aPR, 1.09; CI, 1.01-1.18), and to have not received care from an obstetrician/gynecologist in the year before the interview (aPR, 1.13; CI, 1.04-1.22).
Among 1142 total pregnancies, 69.6% were live births, 7.8% were born HIV positive, and 60% of those born HIV positive were unplanned pregnancies.
Of the 957 women included in the contraceptive analysis, 90.5% reported using at least one contraceptive, including 59.7% reporting barrier methods, 29.9% reporting permanent sterilization, 22.8% reporting short-term methods in the previous year, and 5.3% reporting LARC.
Women who reported use of LARC or depo-progesterone acetate were more likely to be aged 18 to 29 years (aPR, 3.08; CI, 1.61-5.89) or 30 to 39 years (aPR, 2.86; CI, 1.76-4.63) compared with women aged 40 to 44 years.
Overall, the study authors concluded that “these data highlight that there may be opportunities for improved reproductive health management during clinical care visits, including discussions of contraceptive options and pregnancy planning, for women living with HIV infection.”
Sutton MY, Zhou W, Frazier EL. Unplanned pregnancies and contraceptive use among HIV-positive women in care. PLoS One. 2018;13(5): e0197216.