The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women.
OBJECTIVE
To estimate the effect of receiving HIV-positive test results on intentions to have future children and on contraceptive use and to assess the association between pregnancy intentions and pregnancy incidence among HIV-positive women in Malawi.


METHODS
Women of unknown HIV status completed a questionnaire about pregnancy intentions and contraceptive use and then received HIV voluntary counseling and testing (VCT). Women who were HIV-positive and not pregnant were enrolled and followed for 1 year while receiving HIV care and access to family planning (FP) services.


RESULTS
Before receiving their HIV test results, 33% of women reported a desire to have future children; this declined to 15% 1 week later (P < 0.0001) and remained constant throughout follow-up. Contraceptive use increased from 38% before HIV testing to 52% 1 week later (P < 0.0001) and then decreased to 46% by 12 months. The pregnancy incidence among women not reporting a desire to have future children after VCT was less than half of the incidence among women reporting this desire.


CONCLUSIONS
With knowledge of their HIV-positive status, women were less likely to desire future pregnancies. Pregnancy incidence was lower among women not desiring future children. Integration of VCT, FP, and HIV care could prevent mother-to-child HIV transmission.
Hoffman
Irving F
IF
Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC 27599, USA. hoffmani@med.unc.edu
Martinson
Francis E A
FE
Powers
Kimberly A
KA
Chilongozi
David A
DA
Msiska
Emmie D
ED
Kachipapa
Emma I
EI
Mphande
Chimwemwe D
CD
Hosseinipour
Mina C
MC
Chanza
Harriet C
HC
Stephenson
Rob
R
Tsui
Amy O
AO
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003270:Contraceptive Agents / Q000008:administration & dosage*; D003376:Counseling / Q000379:methods / Q000706:statistics & numerical data; D005193:Family Planning Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D006679:HIV Seropositivity / Q000175:diagnosis; D006801:Humans; D008295:Malawi; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control / Q000523:psychology / Q000821:virology; D011275:Pregnancy, Unwanted / Q000523:psychology; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
D019380:Anti-HIV Agents; D003270:Contraceptive Agents