266919 “We weren't using condoms because we were trying to conceive”: The need for reproductive counseling for HIV+ women in clinical care

Monday, October 29, 2012

Sarah Finocchario-Kessler, PhD, MPH , Family Medicine, Kansas University Medical Center, Kansas City, KS
Natabhona Mabachi, PhD, MPH , Family Medicine, Kansas University Medical Center, Kansas City, KS
Jacinda Dariotis, PhD, MAS, MA, MS , Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Kathy Goggin, PhD , Department of Psychology, University of Missouri-Kansas City, Kansas City, MO
Jean Anderson, MD , Department of Gynecology and Obstetrics, Johns Hopkins, Baltimore, MD
K. Allen Greiner, MD, MPH , Center for American Indian Community Health, and Department of Family Medicine, Kansas University Medical Center, Kansas City, KS
Michael Sweat, PhD , Psychiatry and Behavioral Sciences, Medical University of South Caroline, Charleston, SC
Background: Although a significant number of HIV+ women intend to have children in the future, few have the opportunity to work with providers to safely plan pregnancy. Department of Health & Human Services recently published guidelines for HIV preconception counseling to assist providers. We assessed childbearing plans and provider communication with HIV+ women.

Methods: We conducted n=20 semi-structured in depth interviews with HIV+ adolescent and adult women receiving HIV clinical care in an urban setting. Participants were purposively sampled to include diversity in age and childbearing plans. Interview transcripts were analyzed and coded independently by two study team members before reaching consensus on emergent themes.

Results: Among this sample of HIV+ women (mean age =28.8, 95% African-American, 50% on ART, 70% want a child), many reported inconsistent condom use; regardless of their childbearing goals. Women actively trying to conceive recognized the risk to themselves and their partner, but had not talked with their provider. Several women reported some discussion of childbearing with their provider, but the majority reported inaccurate information regarding transmission risks. Data regarding provider dynamics were organized as follows: 1) confusion and concern on how to safely conceive, 2) comfort level discussing childbearing with a provider, and 3) provider guidance offered. Even in this unique setting where referrals for preconception counseling are possible, women were unaware of this specialized service.

Conclusion: Provider initiated reproductive counseling is needed to strategically avoid or plan pregnancy and reduce risk of transmission to partners and infants; versus leaving it to chance.

Learning Areas:
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
1)Describe the variation in provider messages about childbearing that women reported. 2)Name at least four important public health justifications for routine comprehensive reproductive health counseling as part of HIV clinical care. 3)Explain the primary goals of HIV preconception counseling.

Keywords: HIV Risk Behavior, Reproductive Planning

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The content of this abstract reflects the qualitative component of my PhD dissertation research conducted at the Johns Hopkins Hospital. I conducted the interviews and their analyses. I have a PhD in Public Health and am currently a Research Instructor at the Kansas University Medical Center, Department of Family Medicine.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.