Contraception Use, Family Planning, and Unprotected Sex: Few Differences Among HIV-Infected and Uninfected Postpartum Women in Four U.S. States
November 20, 2003
The current study examined attitudes, behavior, and pregnancy rates of women with or at risk for HIV infection at six months postpartum. "Specifically," the researchers wrote, "our objectives were to assess differences in rates of repeat pregnancy, reproductive intentions, and contraceptive and condom use in HIV-positive and HIV-negative women. We also examined behavioral and cognitive factors that may influence condom use."Adapted from:
The investigators studied 258 HIV-seropositive and 228 HIV-seronegative women from prenatal clinics in four U.S. states (Florida, New York, Connecticut and North Carolina) between June 1996-November 1998. Women in the sample were predominantly black or African-American (68 percent) or Hispanic (22 percent), with a mean age of 28 years when interviewed. Forty-five percent of participants had a minimum of high school education, and 12 percent were attending school.
Postpartum, 25 percent of women reported alcohol use, and 7 percent reported crack, cocaine or heroin use. Thirteen percent of women were in a drug treatment, rehabilitation or detoxification program when interviewed. The researchers found no statistically significant differences in rates of drug treatment status or drug use as a function of HIV serostatus; however, HIV-seronegative women were more likely to report alcohol use in the postpartum period.
Subjects completed interviews at 24-40 weeks' gestation and at six months postpartum. At the six-month interview, 78 percent of women reported vaginal sex, and 2 percent were pregnant. Among those not pregnant, 86 percent said there was no likelihood of a pregnancy within the next six months. Sixty-eight percent of sexually active women reported condom use, and 65 percent of users reported consistent use. HIV patients were more likely to report condom use, more likely to report condom use consistency, and less likely to report use of oral contraceptives than women without HIV. In multivariate analysis, the researchers found inconsistent condom use to be associated with postpartum alcohol use, with respondents stating that a pregnancy would not be emotionally upsetting in the next six months, and with reporting an intention to terminate a pregnancy if one were to occur. HIV-seropositive women with at least one child with HIV were less likely than seronegative women to report inconsistent condom use. The investigators found few differences in reproductive behaviors as a function of HIV serostatus, although both cohorts engaged in unprotected sex.
"In contrast to studies done prior to widespread use of antiretroviral medication for prevention of vertical HIV transmission, our study shows very few differences between HIV-seropositive and HIV-seronegative women in terms of reproductive beliefs, attitudes, and behaviors," the authors noted. "... Whether these similarities are due to increases in sexual risk behavior occurring in response to widespread antiretroviral therapy, such as has been documented among populations of men who have sex with men, has yet to be established. Regardless, there is an emerging need to work with HIV-infected women to determine how family planning issues could be linked with prevention efforts to reduce heterosexual HIV transmission. Sexual behaviors resumed shortly after birth for a majority of both HIV-infected and uninfected women. Consequently, pregnancy and the immediate postpartum period present an important opportunity for delivering risk reduction, family planning, and HIV-related messages," the researchers concluded.
Journal of Acquired Immune Deficiency Syndromes
08.15.03; Vol. 33; No. 5: P.608-613; Tracey E. Wilson, Linda Koenig, Jeannette Ickovics, Emmanuel Walter, Amy Suss, M. Isabel Fernandez for the Perinatal Guidelines Evaluation Project
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.