"Throwing the dice": pregnancy decision-making among HIV-positive women in four U.S. cities.
BACKGROUND
Although AIDS-related deaths among U.S. women have decreased, the number of HIV-positive women, especially of reproductive age, has increased. A better understanding of the interaction between HIV and family planning is needed, especially as antiretroviral medications allow HIV-positive women to live longer, healthier lives.


METHODS
Qualitative methods were used to examine pregnancy decision-making among 56 HIV-positive women in four U.S. cities. Biomedical, individual and sociocultural themes were analyzed in groups of women, categorized by their pregnancy experiences and intentions.


RESULTS
Regardless of women's pregnancy experiences or intentions, reproductive decision-making themes included the perceived risk of vertical transmission, which was often overestimated; beliefs about vertical transmission risk reduction strategies; desire for motherhood; stigma; religious values; attitudes of partners and health care providers; and the impact of the mother's health and longevity on the child. Most women who did not want children after their diagnosis cited vertical transmission risk as the reason, and most of these women already had children. Those who became pregnant or desired children after their diagnosis seemed more confident in the efficacy of risk reduction strategies and often did not already have children.


CONCLUSIONS
Future studies may help clarify the relationship between factors that influence pregnancy decision-making among HIV-positive women. HIV-positive and at-risk women of childbearing age may benefit from counseling interventions sensitive to factors that influence infected women's pregnancy decisions.
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, USA.
Sheri B
SB
Kirshenbaum
A Elizabeth
AE
Hirky
Jacqueline
J
Correale
Rise B
RB
Goldstein
Mallory O
MO
Johnson
Mary Jane
MJ
Rotheram-Borus
Anke A
AA
Ehrhardt
D000028:Abortion, Induced / Q000523:psychology; D000328:Adult; D003376:Counseling; D003657:Decision Making; D005260:Female; D006679:HIV Seropositivity / Q000523:psychology* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D015141:Los Angeles; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D009519:New York City; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000523:psychology; D012307:Risk Factors; D012495:San Francisco; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014922:Wisconsin; D016387:Women's Health; D014933:Women's Rights