• You Can Even Possibly Have a Child: Reproduction in the Lives of HIV-Positive Women (MoOrE1067)
  Authored by Donna Barnes
  View the original abstract

At first glance, I was concerned with the title of Dr. Barnes' presentation, "You could even possibly have a child." Depending on the tone one uses while reading that statement, one could envision a talk with little optimism. On the contrary, Dr. Barnes' talk was excellent and addressed the concerns many of my patients share regarding reproduction. The purpose of her talk was to discuss what influences women with HIV/AIDS reproductive decisions and to discuss the results of a small but well-done survey trying to explore women's decisions regarding reproduction. Barnes and colleagues conducted face-to-face interviews with 80 HIV-infected women (30 in California, 20 in Illinois, 30 in New York). The mean age was 35 (range 18-49), and 58 percent were African American. The predominant risk factor for acquiring HIV was heterosexual and/or IVDU. The interviews were recorded, transcribed and subsequently analyzed utilizing grounded theory qualitative methods.

Many of the themes they reported reaffirmed how I was interpreting my own patient population. The major reproductive decisions were influenced by the woman's self-identity of mothering and how this played on her life. Many viewed mothering as "life-sustaining" and the "last chance to be a good mother." Dr. Barnes also addressed the importance of understanding the factors related to women who previously had children removed from their care because of drug-related issues and the need to try again and "do it right this time." Of equal importance was the impact of religious and cultural beliefs.

Dr. Barnes was very direct about providers and their personal judgments affecting and even coercing HIV-positive women to not reproduce. I agree that prior to potent antiretroviral therapy (ART), most providers presented negative aspects of pregnancy in HIV-positive women. With current therapy, the risk of HIV transmission to the infant may be less than 1 percent. The decision to have a baby should be dependent on multiple other factors.

As providers, we need to acknowledge the cultural and religious beliefs of our patients. We need to guide them and reassure them we are there to help. Ideally, every woman of childbearing age should be asked about her thoughts on reproduction. I find this to be a very useful way of opening discussion with my female patients. I, too, probably spend more time emphasizing the need for ART and should spend more time understanding their decision from a cultural and/or religious viewpoint. Dr. Barnes' study suggests that providers need to implement a program aimed at coordinating the education, medical and social services needed for women's reproductive health.

I personally would like to see Dr. Barnes conduct a similar study on HIV-positive female adolescents. A common theme among adolescents regardless of HIV sero-status is to have a baby to "love me." Questions remain on how best to offer assistance and care to young HIV-positive women who are not mentally mature and who need help recognizing the responsibilities of motherhood.