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Reproductive Choices and Decisions for Clients with HIV

Reproductive Choices and Decisions for Clients with HIV. childbearing. pregnancy. contraception. Pregnancy in Women with HIV. Does not accelerate disease One-third pass HIV to newborn during pregnancy, delivery, and breastfeeding Possible increased risk of stillbirth and low birth weight.

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Reproductive Choices and Decisions for Clients with HIV

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  1. Reproductive Choices and Decisions for Clients with HIV childbearing pregnancy contraception

  2. Pregnancy in Women with HIV • Does not accelerate disease • One-third pass HIV to newborn during pregnancy, delivery, and breastfeeding • Possible increased risk of stillbirth and low birth weight Positive developments: • ARV therapy improves health/longevity • PMTCT reduces vertical transmission • Wider availability of support and care services Source: Saada, 2000; Tai, 2007; Brocklehurst, 1998.

  3. Reasons Clients with HIV May Consider Pregnancy • Intense desire to have children • Pressure to have children • Fear that older children may die • Concern about infertility • Reassured by PMTCT • Optimism about ARV therapy • Avoid generating suspicions • Apprehension about disclosing status Source: Preble, 2003.

  4. Reasons Clients with HIV May Avoid Childbearing • Similar concerns to women without HIV: • economic status • desired family size • ideal spacing • Concerns about health and quality of life • Fear of transmitting HIV • Anxiety about leaving orphans • Concerns about limited access to help

  5. In Their Own Words … I would be committing a great sin if I would have another child knowing this one is sick. I would be putting responsibility on other people and killing myself. – Woman on ART People who are unable to have children find it difficult to lead happy lives. – Man on ART When I am married I will have to have a baby because only I and my boyfriend are aware that I am HIV-positive and people will ask why am I not becoming pregnant in marriage. – Woman with HIV The community questions a woman falling pregnant while she knew her HIV status. – Woman with HIV

  6. Access to Information/Services is Key • Consider reproductive choices • Plan for the future • Avoid unintended pregnancy • Time pregnancy when health is optimal • Reduce HIV transmission to children • Reduce transmission to partners Source: Chen, 2001.

  7. Many Women with HIV Want to Use FP Pregnancyrate among women with HIV in Rwandan study 22% During this period, contraceptive use increased from 16% to 24%. 9% Source: King, 1995.

  8. Fertility decision: desire pregnancy? Pregnancy desired No Yes 2. Informeddecision(s):contraceptive method? STI/HIV prevention? Pregnancy Contraceptive Ongoing HIV counseling counseling counseling Intended Safe/effectivecontraception pregnancy 3. Treatment decision(s): ARV therapy for self and partner? PMTCT? ARV PMTCT treatment services No Yes No Yes Choices for Clients with HIV Adapted from: Cates, 2001.

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