Reproductive desire in women with HIV infection in Spain, associated factors and motivations: a mixed-method study

BMC Pregnancy and Childbirth

Alicia Llácer²  Isabel Rio²  Ignacio de los Santos⁷  Jorge del Romero⁶  Mar Masiá³  Jose Ramón Blanco¹  Mª Jesús Pérez-Elías⁴  Marta Montero⁵  Débora Álvarez²  Belén Alejos²  Victoria Hernando² 

[1] Hospital Universitario San Pedro-CIBIR, Logroño, Spain;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Hospital Universitario de Elche, Alicante, Spain;Hospital Universitario Ramón y Cajal, Madrid, Spain;Hospital Universitario La Fe, Valencia, Spain;Centro Sanitario Sandoval, Madrid, Spain;Hospital Universitario La Princesa, Madrid, Spain

关键词: Social support;    Disclosure;    Women;    HIV infection;    Reproductive desire;   

Others  :  1127244
DOI  :  10.1186/1471-2393-14-194

 received in 2013-12-10, accepted in 2014-05-28,  发布年份 2014

【 摘 要 】

Background

Antiretroviral therapy has created new expectations in the possibilities of procreation for persons living with HIV. Our objectives were to evaluate reproductive desire and to analyze the associated sociodemographic and clinical factors in HIV-infected women in the Spanish AIDS Research Network Cohort (CoRIS).

Methods

A mixed qualitative-quantitative approach was designed. Women of reproductive age (18–45) included in CoRIS were interviewed by phone, and data were collected between November 2010 and June 2012 using a specifically designed questionnaire. Reproductive desire was defined as having a desire to be pregnant at present or having unprotected sex with the purpose of having children or wanting to have children in the near future.

Results

Overall, 134 women were interviewed. Median age was 36 years (IQR 31–41), 55% were Spanish, and 35% were unemployed. 84% had been infected with HIV through unprotected sex, with a median time since diagnosis of 4.5 years (IQR 2.9-6.9). Reproductive desire was found in 49% of women and was associated with: 1) Age (women under 30 had higher reproductive desire than those aged 30–39; OR = 4.5, 95% CI 1.4-14.3); 2) having no children vs. already having children (OR = 3.2; 1.3-7.7 3); Being an immigrant (OR = 2.2; 1.0-5.0); and 4) Not receiving antiretroviral treatment (OR = 3.6; 1.1-12.1). The main reasons for wanting children were related to liking children and wanting to form a family. Reasons for not having children were HIV infection, older age and having children already. Half of the women had sought or received information about how to have a safe pregnancy, 87% had disclosed their serostatus to their family circle, and 39% reported having experienced discrimination due to HIV infection.

Conclusions

The HIV-infected women interviewed in CoRIS have a high desire for children, and the factors associated with this desire are not fundamentally different from those of women in the general population. Maternity may even help them face a situation they still consider stigmatized and prefer not to disclose. Health-care protocols for handling HIV-positive women should incorporate specific interventions on sexual and reproductive health to help them fulfill their procreation desire and experience safe pregnancies.

【 授权许可】

   
2014 Hernando et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Ray M, Logan R, Sterne JA, Hernandez-Diaz S, Robins JM, Sabin C, Bansi L, van Sighem A, de Wolf F, Costagliola D, Lanoy E, Bucher HC, von Wyl V, Esteve A, Casbona J, del Amo J, Moreno S, Justice A, Goulet J, Lodi S, Phillips A, Seng R, Meyer L, Perez-Hoyos S, de Olalla G, Hernan MA: The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS 2010, 24:123-137.
• [2]European Collaborative Study: Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 2005, 40:458-465.
• [3]Heard I, Sitta R, Lert F: Reproductive choice in men and women living with HIV: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA Study). AIDS 2007, 21(Suppl 1):S77-S82.
• [4]Ogilvie GS, Palepu A, Remple VP, Maan E, Heath K, MacDonald G, Christilaw J, Berkowitz J, Fisher WA, Burdge DR: Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada. AIDS 2007, 21(Suppl 1):S83-S88.
• [5]Panozzo L, Battegay M, Friedl A, Vernazza PL: High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner–two challenging issues. Swiss Med Wkly 2003, 133:124-127.
• [6]Ivanova EL, Hart TA, Wagner AC, Aljassem K, Loutfy MR: Correlates of anxiety in women living with HIV of reproductive age. AIDS Behav 2012, 16:2181-2191.
• [7]Wagner AC, Hart TA, Mohammed S, Ivanova E, Wong J, Loutfy MR: Correlates of HIV stigma in HIV-positive women. Arch Womens Ment Health 2010, 13:207-214.
• [8]Centro Nacional de Epidemiología: Vigilancia Epidemiológica del VIH/SIDA en España. Situación 30 junio 2012. 2012. http://www.isciii.es/ISCIII/es/contenidos/fd-servicios-cientifico-tecnicos/fd-vigilancias-alertas/fd-enfermedades/fd-sida/Informe-VIH-sida-Junio-2012.pdf webcite
• [9]Caro-Murillo AM, Castilla J, Perez-Hoyos S, Miro JM, Podzamczer D, Rubio R, Riera M, Viciana P, Lopez AJ, Iribarren JA, de los Santos-Gil I, Gomez-Sirvent JL, Berenguer J, Gutierrez F, Saumoy M, Segura F, Soriano V, Pena A, Pulido F, Oteo JA, Leal M, Casabona J, del Amo J, Moreno S: Spanish cohort of naive HIV-infected patients (CoRIS): rationale, organization and initial results. Enferm Infecc Microbiol Clin 2007, 25:23-31.
• [10]Sobrino-Vegas P, Gutierrez F, Berenguer J, Labarga P, Garcia F, Alejos-Ferreras B, Munoz MA, Moreno S, del Amo J: [The cohort of the Spanish HIV research network (coris) and its associated biobank; organizational issues, main findings and losses to follow-up]. Enferm Infecc Microbiol Clin 2011, 29:645-653.
• [11]Gjesfjeld CD, Greeno CG, Kim KH: A confirmatory factor analysis of an abbreviated social support instrument: the MOS-SSS. Res Soc Work Pract 2008, 18:231-237.
• [12]Fiore S, Heard I, Thorne C, Savasi V, Coll O, Malyuta R, Niemiec T, Martinelli P, Tibaldi C, Newell ML: Reproductive experience of HIV-infected women living in Europe. Hum Reprod 2008, 23:2140-2144.
• [13]Craft SM, Delaney RO, Bautista DT, Serovich JM: Pregnancy decisions among women with HIV. AIDS Behav 2007, 11:927-935.
• [14]Badell ML, Lathrop E, Haddad LB, Goedken P, Nguyen ML, Cwiak CA: Reproductive healthcare needs and desires in a cohort of HIV-positive women. Infect Dis Obstet Gynecol 2012, 2012:107878. 2012:107878. doi:10.1155/2012/107878. Epub;%2012 Jun 13
• [15]Homsy J, Bunnell R, Moore D, King R, Malamba S, Nakityo R, Glidden D, Tappero J, Mermin J: Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS One 2009, 4:e4149.
• [16]Loutfy MR, Hart TA, Mohammed SS, Su D, Ralph ED, Walmsley SL, Soje LC, Muchenje M, Rachlis AR, Smaill FM, Angel JB, Raboud JM, Silverman MS, Tharao WE, Gough K, Yudin MH: Fertility desires and intentions of HIV-positive women of reproductive age in Ontario, Canada: a cross-sectional study. PLoS One 2009, 4:e7925.
• [17]French CE, Cortina-Borja M, Thorne C, Tookey PA: Incidence, patterns, and predictors of repeat pregnancies among HIV-infected women in the United Kingdom and Ireland, 1990–2009. J Acquir Immune Defic Syndr 2012, 59:287-293.
• [18]Nattabi B, Li J, Thompson SC, Orach CG, Earnest J: A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav 2009, 13:949-968.
• [19]Barona-Vilar C, Mas-Pons R, Fullana-Montoro A, Giner-Monfort J, Grau-Munoz A, Bisbal-Sanz J: Perceptions and experiences of parenthood and maternal health care among Latin American women living in Spain: a qualitative study. Midwifery 2012, 29(4):332-337.
• [20]Laursen T, Kesmodel US, Hojgaard A, Ostergaard L, Ingerslev HJ, Wejse C: Reproductive patterns and fertility wishes among HIV-infected patients: survey from six outpatient clinics in Denmark. Int J Infect Dis 2013, 17(10):e851-e856.
• [21]Beyeza-Kashesya J, Ekstrom AM, Kaharuza F, Mirembe F, Neema S, Kulane A: My partner wants a child: a cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health 2010, 10:247:247.
• [22]Maier M, Andia I, Emenyonu N, Guzman D, Kaida A, Pepper L, Hogg R, Bangsberg DR: Antiretroviral therapy is associated with increased fertility desire, but not pregnancy or live birth, among HIV + women in an early HIV treatment program in rural Uganda. AIDS Behav 2009, 13 Suppl 1:28–37. Epub;2008 Apr 4:28-37.
• [23]da Silveira RA, Fonsechi-Carvasan GA, Makuch MY, Amaral E, Bahamondes L: Factors associated with reproductive options in HIV-infected women. Contraception 2005, 71:45-50.
• [24]Zhang Y, Margolese S, Yudin MH, Raboud JM, Diong C, Hart TA, Shapiro HM, Librach C, Gysler M, Loutfy MR: Desires, need, perceptions, and knowledge of assisted reproductive technologies of HIV-positive women of reproductive Age in Ontario, Canada. ISRN Obstet Gynecol 2012, 2012:853503. doi: 10.5402/2012/853503. Epub;%2012 Aug 16:853503.
• [25]Brickley DB, Le Dung HD, Nguyet LT, Mandel JS, Giang lT, Sohn AH: Community, family, and partner-related stigma experienced by pregnant and postpartum women with HIV in Ho Chi Minh City, Vietnam. AIDS Behav 2009, 13:1197-1204.
• [26]Kanniappan S, Jeyapaul MJ, Kalyanwala S: Desire for motherhood: exploring HIV-positive women’s desires, intentions and decision-making in attaining motherhood. AIDS Care 2008, 20:625-630.
• [27]King R, Khana K, Nakayiwa S, Katuntu D, Homsy J, Lindkvist P, Johansson E, Bunnell R: ‘Pregnancy comes accidentally--like it did with me’: reproductive decisions among women on ART and their partners in rural Uganda. BMC Public Health 2011, 11:530:530.
• [28]Myer L, Morroni C, El-Sadr WM: Reproductive decisions in HIV-infected individuals. Lancet 2005, 366:698-700.
• [29]Barnes DB, Murphy S: Reproductive decisions for women with HIV: motherhood’s role in envisioning a future. Qual Health Res 2009, 19:481-491.
• [30]Siegel K, Schrimshaw EW: Reasons and justifications for considering pregancy among women living with HIV/AIDS. Psychol Women Quartely 2001, 25:112-123.
• [31]Centro de Investigaciones Sociológicas: Encuesta “Fecundidad y Valores en la España del siglo XXI”. Estudio º 2.639. 2013. http://www.cis.es/cis/opencms/-Archivos/Marginales/2620_2639/2639/Es2639_mapa_pdf.html webcite
• [32]Centro de Investigaciones Sociológicas: Encuesta sobre actitudes y Opiniones de las Mujeres antes los Hijos y la Crianza. Estudio º 2.552. 2013. http://www.cis.es/cis/opencms/-Archivos/Marginales/2540_2559/2552/Es2552mar.pdf webcite
• [33]Bastardo YM, Kimberlin CL: Relationship between quality of life, social support and disease-related factors in HIV-infected persons in Venezuela. AIDS Care 2000, 12:673-684.
• [34]Remor E: Social support and quality of life in the HIV infection. Aten Primaria 2002, 30:143-148.
• [35]Rice E, Comulada S, Green S, Arnold EM, Rotheram-Borus MJ: Differential disclosure across social network ties among women living with HIV. AIDS Behav 2009, 13:1253-1261.
• [36]Ministerio de Sanidad SSel: Registro de Centros de Reproducción Asistida. 2013. http://www.ine.es/inebmenu/mnu_padron.htm webcite
• [37]Ministerio de Sanidad SSel: Normativa. 2013. http://www.cnrha.msssi.gob.es/normativa/home.htm webcite
• [38]Instituto Nacional de Estadistica: Estadistica del Padrón Continuo. 2013. http://www.ine.es/inebmenu/mnu_padron.htm webcite
• [39]Instituto Nacional de Estadistica: Movimiento Natural de la Población. 2013. http://www.ine.es/jaxi/menu.do?type=pcaxis&path=%2Ft20%2Fe304&file=inebase&L=0 webcite
• [40]Holgado-Juan M, Holgado-Juan MC, Garcia-Ron MT, Esteban-Fernandez FJ, Prieto-Tato LM, Ramos-Amador JT: [Characteristics of a cohort of pregnant women with human immunodeficiency virus infection]. Enferm Infecc Microbiol Clin 2013, 31:147-151.
• [41]Lopez-Vilchez MA, Guxens JM, Mur ME, Mur SA: [HIV-mother-to-child transmission in a tertiary hospital in the era of generalization of preventive interventions]. Med Clin (Barc) 2009, 132:487-494.
• [42]Centro Nacional de Epidemiología: Anonymous unlinked study of the prevalence of anti-HIV antibodies in mothers of live newborns from 6 Autonomous Regions, 2003–2009. 2013. http://www.isciii.es/ISCIII/es/contenidos/fd-servicios-cientifico-tecnicos/fd-vigilancias-alertas/fd-enfermedades/fd-sida/InformeRNVIH2003_2010.pdf webcite