The Year-Long Effect of HIV-Positive Test Results on Pregnancy Intentions, Contraceptive Use, and Pregnancy Incidence Among Malawian Women

Authors:
  • FMFrancis E A Martinson
    Francis E A Martinson
  • KPKimberly A Powers
    Kimberly A Powers
  • DCDavid A Chilongozi
    David A Chilongozi
  • EMEmmie D Msiska
    Emmie D Msiska
  • EKEmma I Kachipapa
    Emma I Kachipapa
  • CMChimwemwe D Mphande
    Chimwemwe D Mphande
  • MHMina C Hosseinipour
    Mina C Hosseinipour
  • HCHarriet C Chanza
    Harriet C Chanza
  • RSRob Stephenson
    Rob Stephenson
  • ATAmy O Tsui
    Amy O Tsui
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Abstract
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. 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. 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. 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.

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