title: Trajectories of Childbearing among HIV Infected Indian Women: A Sequence Analysis Approach.
abstract: BACKGROUND
  HIV infection closely relates to and deeply affects the reproductive career of those infected. However, little is known about the reproductive career trajectories, specifically the interaction of the timing of HIV diagnosis with the timing and sequencing of reproductive events among HIV infected women. This is the first study to describe and typify this interaction.
  
  
  METHODS
  Retrospective calendar data of ever married HIV infected women aged 15-45 attending a HIV clinic in Pune, Maharashtra, Western India (N=622) on reproductive events such as marriage, cohabitation with the partner, use of contraception, pregnancy, childbirth and HIV diagnosis were analyzed using sequence analysis and multinomial logistic regression.
  
  
  RESULTS
  Optimal matching revealed three distinct trajectories: 1) HIV diagnosis concurrent with childbearing (40.7%), 2) HIV diagnosis after childbearing (32.1%), and 3) HIV diagnosis after husband's death (27.2%). Multinomial logistic regression (trajectory 1 = baseline) showed that women who got married before the age of 21 years and who had no or primary level education had a significantly higher risk of knowing their HIV status either after childbearing or close to their husband's death. The risk of HIV diagnosis after husband's death was also higher among rural women and those who were diagnosed before 2005.
  
  
  CONCLUSIONS
  Three distinct patterns of interaction of timing of HIV diagnosis with timing and sequencing of events in the reproductive career were observed that have clear implications for (i) understanding of the individual life planning process in the context of HIV, (ii) formulation of assumptions for estimating HIV infected women in need of PMTCT services, and (iii) provision of care services.
authors.affiliation: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands; PRAYAS Health Group, Pune, Maharashtra, India.
authors.forename: Shrinivas
authors.initials: S
authors.lastname: Darak
authors.affiliation: Department of Sociology, Nuffield College, University of Oxford, Oxford, England.
authors.forename: Melinda
authors.initials: M
authors.lastname: Mills
authors.affiliation: PRAYAS Health Group, Pune, Maharashtra, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kulkarni
authors.affiliation: PRAYAS Health Group, Pune, Maharashtra, India.
authors.forename: Sanjeevani
authors.initials: S
authors.lastname: Kulkarni
authors.affiliation: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Hutter
authors.affiliation: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands; Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands.
authors.forename: Fanny
authors.initials: F
authors.lastname: Janssen
mesh_terms: D000293:Adolescent; D000328:Adult; D003710:Demography; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007194:India; D016015:Logistic Models; D008393:Marriage; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D012747:Sexual Partners; D012959:Socioeconomic Factors; D055815:Young Adult