A.18.Pregnancy intentions and contraceptive practices of Malawian women before and after notification of positive HIV status
Chilongozi D, Martinson F, Hoffman I, Stephenson R, Chanza H, Nkhalamba T
Objectives: This prospective cohort study examined self-reported sexual activity, intentions to become pregnant, and contraceptive practices among HIV-positive women prior to HIV status notification and then longitudinally for one year.
Methods: Women were recruited from three clinics at KCH. At screening, subjects completed a questionnaire about their sexual activity, contraceptive practices, and intentions to become pregnant, and then underwent HIV testing. At an enrollment visit one week later, HIV-positive subjects again completed the questionnaire. They returned for a third visit within three months of enrollment, and quarterly thereafter.
Results: 191 HIV-positive women were enrolled. Median CD4 count at screening was 298 (IQR: 152, 521). Reported contraceptive use increased from 40% at screening to 57% at enrollment and 61% at visit 3. The percentage of women reporting a desire to become pregnant decreased from 35% at screening to 14% and 15% at enrollment and visit 3, respectively. The percentage reporting sexual activity increased from 36% at enrollment to 62% at visit 3. Among those reporting sexual activity at visit 3, 11% reported using condoms, 32% depo provera, and 1% implants to prevent pregnancy. Of the 63 sexually active women at visit 3 who reported not wanting to become pregnant, 81% reported using contraceptives; however, 54% did not provide any positive responses when asked about a range of specific contraceptive options.
Conclusion(s): Following notification of positive HIV test results, the percentage of subjects reporting a desire to become pregnant declined, and the percentage reporting contraceptive use increased; however, fewer than 15% of sexually active subjects reported using condoms within three months of receiving positive results.
Recommendations: Efforts should be made to counsel HIV-positive women about the risk of MTCT, to encourage contraceptive methods, and to promote the effectiveness of condoms in preventing transmission to sexual partners.