Skip to main content

Advertisement

SpringerLink
Log in

Discussing Childbearing with HIV-infected Women of Reproductive Age in Clinical Care: A Comparison of Brazil and the US

  • Original Research
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Despite long term access to highly active antiretroviral therapy in Brazil and the US, little is known about women’s communication with their HIV provider regarding childbearing or the unmet need for reproductive counseling. We utilized identical survey questions to collect data from HIV-infected women of reproductive age in Rio de Janeiro (n = 180) and Baltimore (n = 181). We conducted univariate analyses to compare findings between samples of women and multivariate logistic regression to determine factors associated with childbearing desires, childbearing intentions, and provider communication among the combined sample of women (n = 361). Over one-third of women in Rio de Janeiro and nearly one-half of women in Baltimore reported the desire for future childbearing. Nevertheless, the majority of women in clinical care had not discussed future childbearing with their HIV provider. Even in countries with an advanced approach to HIV care, we found low and inadequate communication between providers and female patients about childbearing.

Resumen

Al pesar del acceso a largo plazo a la terapia antiretroviral en Brasil y en los Estados Unidos, hay poco conocimiento al respecto de la comunicación entre las mujeres viviendo com VIH y sus médicos en cuanto a sus deseos de tener mas hijos o la necesidad del consejo relacionado con la reproduccion. En este estudio utilizamos preguntas identicas en los dos estudios para coleccionar datos entre las mujeres infectadas con VIH de edad reproductiva, 180 viviendo en Rio de Janeiro y 181 viviendo en Baltimore. Condujimos análisis univariados para comparar los resultados entre las muestras de mujeres y la regressión logistica multivariada para determinar los factores asociados con los deseos de parir, incluyendo las intenciones para parir y la comunicación de los medicos HIV entre 361 mujeres. Más de un tercio de mujeres en Rio de Janeiro y casi una mitad de las mujeres en Baltimore reportaron que desearon parir en el futuro. Sin embargo, la mayoría de las mujeres no había discutido con sus médicos su deseo de parir en el futuro. Aun en los países con un enfoque avanzado en relacion al atendimiento clinic para HIV, nos dimos cuenta que hay una comunicación insuficiente acerca del deseo de tener mas hijos entre los medicos de HIV y sus pacientes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nóbrega AA, Oliveira FA, Galvão MT, Mota RS, Barbosa RM, Dourado I, Kendall C, Kerr-Pontes LR. Desire for a child among women living with HIV/AIDS in northeast Brazil. AIDS Patient Care STDS. 2007;21(4):261–7.

    Article  PubMed  Google Scholar 

  2. Paiva V, Santos N, França-Junior I, Filipe E, Ayres JR, Segurado A. Desire to have children: gender and reproductive rights of men and women living with HIV: a challenge to health care in Brazil. AIDS Patient Care STDS. 2007;21(4):268–77.

    Article  PubMed  Google Scholar 

  3. Panozzo L, Battegay M, Friedl A, Vernazza PL. High risk behaviour and fertility desires among heterosexual HIV positive patients with a serodiscordant partner—two challenging issues. Swiss Med Wkly. 2003;133(7–8):124–7.

    PubMed  Google Scholar 

  4. Finocchario-Kessler S, Sweat MD, Dariotis JK, Trent ME, Kerrigan DL, Keller JM, Anderson JR. Understanding high fertility desires and intentions among a sample of urban women living with HIV in the United States. AIDS Behav. 2010;14(5):1106–14.

    Article  PubMed  Google Scholar 

  5. Loutfy MR, Hart TA, Mohammed SS, Su D, Ralph ED, Walmsley SL, Soje LC, Muchenje M, Rachlis AR, Smaill FM, Angel JB, Raboud JM, Silverman MS, Tharao WE, Gough K, Yudin MH. Ontario HIV fertility Research Team. Fertility desires and intentions of HIV-positive women of reproductive age in Ontario, Canada: a cross-sectional study. PLoS One. 2009;4(12):e7925.

    Article  PubMed  Google Scholar 

  6. Chen JL, Phillips KA, Kanouse DE, Collins RL, Miu A. Fertility desires and intentions of HIV-positive men and women. Fam Plann Perspect. 2001;33(4):144–52.

    Article  PubMed  CAS  Google Scholar 

  7. Myer L, Akugizibwe P. Impact of HIV treatment scale-up on women’s reproductive health care and reproductive rights in Southern Africa. J Acquir Immune Defic Syndr. 2009;52(Suppl 1):S52–3.

    PubMed  Google Scholar 

  8. Cooper D, Moodley J, Zweigenthal V, Bekker LG, Shah I, Myer L. Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS Behav. 2009;13(1):38–46. Epub 2009 Apr 3.

    Article  PubMed  Google Scholar 

  9. Schoen R, Kim YJ, Nathanson CA, Fields J, Aston NM. Why do Americans want children? Popul Dev Rev. 1997;23:333–58.

    Google Scholar 

  10. Dyer SJ. The value of children in African countries: insights from studies on infertility. J Psychosom Obstet Gynaecol. 2007;28(2):69–77.

    Article  PubMed  Google Scholar 

  11. United Nations Programme for HIV/AIDS (UNAIDS), United Nations Population Fund (UNFPA) and United Nations Development Fund for Women (UNIFEM). 2004. Women and HIV/AIDS: Confronting the Crisis. Available at http://www.unfpa.org/hiv/women/docs/women_aids.pdf. Accessed 2 October 2010.

  12. Bedimo AL, Bessinger R, Kissinger P. Reproductive choices among HIV-positive women. Soc Sci Med. 1998;46(2):171–9. doi:10.1016/S0277-9536(97)00157-3.

    Article  PubMed  CAS  Google Scholar 

  13. Santos N, Ventura-Filipe E, Paiva V. HIV positive women, reproduction and sexuality in Saõ Paulo, Brazil. Reprod Health Matters. 1998;6(12):31–40. doi:10.1016/S0968-8080(98)90005-2.

    Article  Google Scholar 

  14. Sowell RL, Phillips KD, Misener TR. HIV-infected women and motivation to add children to their families. J Fam Nurs. 1999;5(3):316–31. doi:10.1177/107484079900500305.

    Article  Google Scholar 

  15. Siegel K, Schrimshaw EW. Reasons and justifications for considering pregnancy among women living with HIV/AIDS. Psychol Women Q. 2001;25(2):112–23. doi:10.1111/1471-6402.00013.

    Article  Google Scholar 

  16. Santos NJ, Buchalla CM, Fillipe EV, Bugamelli L, Garcia S, Paiva V. Reproduction and sexuality in HIV-positive women, Brazil. Rev Saude Publica. 2002;36(4 Suppl):12–23.

    Article  PubMed  Google Scholar 

  17. Centers for Disease Control, Prevention. Epidemiology of HIV/AIDS—United States, 1981–2005. MMWR Weekly. 2006;55(21):589–92.

    Google Scholar 

  18. Ministry of Health, Brazil. Consenso sobre Terapia Anti-retroviral para Adultos e Adolescentes Infectados pelo HIV. Brasilia, DF, Brazil: Brazilian Ministry of Health; 1997.

    Google Scholar 

  19. Segurado AC, Paiva V. Rights of HIV positive people to sexual and reproductive health: parenthood. Reprod Health Matters. 2007;15(29 Suppl):27–45.

    Article  PubMed  Google Scholar 

  20. Kirshenbaum SB, Hirky AE, Correale J, Goldstein RB, Johnson MO, Rotheram-Borus MJ, Ehrhardt AA. “Throwing the dice”: pregnancy decision-making among HIV-positive women in four U.S. cities. Perspect Sex Reprod Health. 2004;36(3):106–13.

    Article  PubMed  Google Scholar 

  21. Craft SM, Delaney RO, Bautista DT, Serovich JM. Pregnancy decisions among women with HIV. AIDS Behav. 2007;11(6):927–35. doi:10.1007/s10461-007-9219-6.

    Article  PubMed  Google Scholar 

  22. Mantell JE, Smit JA, Stein ZA. The right to choose parenthood among HIV-infected women and men. J Public Health Policy. 2009;30(4):367–78.

    Article  PubMed  Google Scholar 

  23. London L, Orner PJ, Myer L. ‘Even if you’re positive, you still have rights because you are a person’: human rights and the reproductive choice of HIV-positive persons. Dev World Bioeth. 2008;8(1):11–22.

    Article  PubMed  Google Scholar 

  24. Semprini AE, Bujan L, Englert Y, Smith CG, Guibert J, Hollander L, Ohl J, Vernazza P. Establishing the safety profile of sperm washing followed by ART for the treatment of HIV discordant couples wishing to conceive. Hum Reprod. 2007;22(10):2793–4; author reply 2794-5. Epub 2007 Jul 3.

    Article  PubMed  CAS  Google Scholar 

  25. Nicopoullos J, Almeida P, Vourliotis M, Goulding R, Gilling-Smith C. A decade of sperm washing: clinical correlates of successful insemination. Hum Reprod. 2010;25(8):1869–76.

    Google Scholar 

  26. Vandermaelen A, Englert Y. Human immunodeficiency virus serodiscordant couples on highly active antiretroviral therapies with undetectable viral load: conception by unprotected sexual intercourse or by assisted reproduction techniques? Hum Reprod. 2010;25(2):374–9. Epub 2009 Nov 26.

    Article  PubMed  Google Scholar 

  27. Matthews LT, Mukherjee JS. Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS Behav. 2009;13(Suppl 1):5–11. Epub 2009 Apr 4.

    Article  PubMed  Google Scholar 

  28. Barreiro P, Castilla JA, Labarga P, Soriano V. Is natural conception a valid option for HIV-serodiscordant couples? Hum Reprod. 2007;22(9):2353–8. Epub 2007 Jul 19.

    Article  PubMed  Google Scholar 

  29. Aaron EZ, Criniti SM. Preconception health care for HIV-infected women. Top HIV Med. 2007;15(4):137–41.

    PubMed  Google Scholar 

  30. Beyeza-Kashesya J, Ekstrom AM, Kaharuza F, Mirembe F, Neema S, Kulane A. My partner wants a child: a cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health. 2010;10:247.

    Article  PubMed  Google Scholar 

  31. Kanniappan S, Jeyapaul MJ, Kalyanwala S. Desire for motherhood: exploring HIV-positive women’s desires, intentions and decision-making in attaining motherhood. AIDS Care. 2008;20(6):625–30.

    Article  PubMed  CAS  Google Scholar 

  32. Paiva V, Latorre Mdo R, Gravato N, Lacerda R, Ayres JR, Segurado A, Aratangy A, Cassia B, Marques HH, França I Jr, Salomão ML. Enhancing care initiative—Brazil. Cad Saude Publica. 2002;18(6):1609–20. Portuguese.

    Article  PubMed  Google Scholar 

  33. Bridge D, Hodder A, Squires K, et al. Clinicians fail to routinely provide reproductive counseling to HIV-infected women in the United States. Abstract TUPE0911 presented at the XVII International AIDS conference. Mexico City, Mexico: August 3–8, 2008.

  34. Finocchario-Kessler S, Dariotis JK, Sweat MD, Trent ME, Keller JM, Hafeez Q, Anderson JR. Do HIV-infected women want to discuss reproductive plans with providers, and are those conversations occurring? AIDS Patient Care STDS. 2010;24(5):317–23.

    Article  PubMed  Google Scholar 

  35. Malta M, Todd C, Stibich M, Garcia T, Pacheco D, Bastos FI. Patient-provider communication and reproductive health among HIV-positive women in Rio de Janeiro, Brazil. Patient Educ Couns. (in press).

  36. Szwarcwald CL, Barbosa Júnior A, Souza-Júnior PR, Lemos KR, Frias PG, Luhm KR, Holcman MM. Esteves MA: HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil. Braz J Infect Dis. 2008;12:167–72.

    Article  PubMed  Google Scholar 

  37. AIDS Administration, Maryland Department of Health and Mental Hygiene. Baltimore City Epidemiologic Profile, Fourth Quarter, 2007. http://www.dhmh.state.md.us/AIDS/Data&Statistics/NewBalQtrEpi.pdf. Accessed 16 November 2008.

  38. Brasil. Ministério da Saúde. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher—PNDS 2006: dimensões do processo reprodutivo e da saúde da criança/Ministério da Saúde, Centro Brasileiro de Análise e Planejamento.—Brasília : Ministério da Saúde, 2009.

  39. Centers for Disease Control and Prevention (CDC) US National Vital Statistics Report for 2007, published 2009. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf. Accessed 12 September 2010.

  40. Tornatore M, Gonçalves CV, Mendoza-Sassi RA, Silveira JM, D’ávila NE, Maas CG, Bianchi MS, Pinheiro EM, Machado ES, Soares MA, Martinez AM. HIV-1 vertical transmission in Rio Grande, Southern Brazil. Int J STD AIDS. 2010;21(5):351–5.

    Article  PubMed  CAS  Google Scholar 

  41. Centers for Disease Control and Prevention. HIV/AIDS Fact Sheet: Mother-to-child (Perinatal) HIV transmission. 2007. Available at http://www.cdc.gov/hiv/topics/perinatal/resources/factsheets/pdf/perinatal.pdf. Accessed 22 August 2010.

  42. Barcellos C, Acosta LM, Lisboa E, Bastos FI. Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators. Rev Saude Publica. 2009;43(6):1006–14.

    Article  PubMed  Google Scholar 

  43. Matida LH, Ramos AN Jr, Heukelbach J, Hearst N. Brazilian Study Group on Survival of Children with AIDS continuing improvement in survival for children with acquired immunodeficiency syndrome in Brazil. Pediatr Infect Dis J. 2009;28(10):920–2.

    Article  PubMed  Google Scholar 

  44. da Silveira Rossi A, Fonsechi-Carvasan GA, Makuch MY, Amaral E, Bahamondes L. Factors associated with reproductive options in HIV-infected women. Contraception. 2005;71(1):45–50.

    Article  PubMed  Google Scholar 

  45. Fehringer J, Bastos FI, Massard E, Maia L, Pilotto JH, Kerrigan D. Supporting adherence to highly active antiretroviral therapy and protected sex among people living with HIV/AIDS: the role of patient-provider communication in Rio de Janeiro, Brazil. AIDS Patient Care STDS. 2006;20(9):637–48.

    Article  PubMed  Google Scholar 

  46. Beach MC, Saha S, Korthuis PT, Sharp V, Cohn J, Wilson I, Eggly S, Cooper LA, Roter D, Sankar A, Moore R. Differences in patient-provider communication for Hispanic compared to non-Hispanic white patients in HIV care. J Gen Intern Med. 2010;25(7):682–7. Epub 2010 Mar 18.

    Article  PubMed  Google Scholar 

  47. Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94:2084–90.

    Article  PubMed  Google Scholar 

  48. Hodder S, Aberg J, Feinberg J, Averitt Bridge D, Abrams S, Storfer S, Squires K. Perceptions of Care by HIV-infected Women of Color in the United States. Presented at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC/IDSA) Meeting October 25–28, 2008, Washington, DC.

  49. Squires K, Averitt Bridge D, Aberg J, Feinberg J, Abrams S, Storfer S, Hodder S. Societal stigma of pregnant HIV-infected women in the United States. Abstract TUPE0908 presented at the XVII International AIDS Conference Mexico City 3–8 August 2008.

  50. Paiva V, Filipe EV, Santos N, Lima TN, Segurado A. The right to love: the desire for parenthood among men living with HIV. Reprod Health Matters. 2003;11(22):91–100.

    Article  PubMed  Google Scholar 

  51. Barreiro P, Duerr A, Beckerman K, Soriano V. Reproductive options for HIV-serodiscordant couples. AIDS Rev. 2006;8(3):158–70. Review.

    PubMed  Google Scholar 

  52. Harries J, Cooper D, Myer L, Bracken H, Zweigenthal V, Orner P. Policy maker and health care provider perspectives on reproductive decision-making amongst HIV-infected individuals in South Africa. BMC Public Health. 2007;7:282.

    Article  PubMed  Google Scholar 

  53. Sherr L, Barry N. Fatherhood and HIV-positive heterosexual men. HIV Medicine. 2004;5(4):258–63.

    Article  PubMed  CAS  Google Scholar 

  54. Oladapo OT, Daniel OJ, Odusoga OL, Ayoola-Sotubo O. Fertility desires and intentions of HIV-positive patients at a suburban specialist center. J Natl Med Assoc. 2005;97:1672–81.

    PubMed  Google Scholar 

  55. Williams ML, Freeman RC, Bowen AM, et al. A comparison of the reliability of self-reported drug use and sexual behaviors using computer-assisted versus face-to-face interviewing. AIDS Educ Prev. 2000;12:199–213.

    PubMed  CAS  Google Scholar 

  56. Ghanem Ghanem KG, Hutton HE, Zenilman JM, Zimba R, Erbelding EJ. Audio computer assisted self interview and face to face interview modes in assessing response bias among STD clinic patients. Sex Transm Infect. 2005;81(5):421–5.

    Article  Google Scholar 

Download references

Acknowledgments

We thank the women in Rio de Janeiro and Baltimore for their participation in this study and acknowledge The Rio Collaborative Group: Betina Durovni & Rosa Domingues (Municipal Secretariat of Health); Louise Schilkowsky, Lia Adler Cherman, Rosane Messias da Silva, Paulo Roberto N. dos Santos, Naja da Silva Reis, Maria Isabel F. Lima (on behalf of the network of health units); Diego Pacheco & Thais Garcia (field coordinators) and participating clinicians and staff at the study clinics. The study in Brazil was funded by the Ford Foundation, Brazil office. We also thank the HIV Women’s Program in Baltimore for their financial support for participant remuneration.

Author information

Authors and Affiliations

  1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Sarah Finocchario-Kessler, M. Sweat & D. Kerrigan

  2. Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

    F. I. Bastos, M. Malta & N. Bertoni

  3. Department of Obstetrics & Gynecology, Johns Hopkins School of Medicine, Baltimore, MD, USA

    J. Anderson

  4. HIV Research Group, University of Missouri-Kansas City, Kansas City, MO, USA

    Sarah Finocchario-Kessler & K. Goggin

  5. Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    J. Dariotis

  6. Fulbright/CAPES visiting scholar at Brown University, Providence, RI, USA

    F. I. Bastos

  7. 4825 Troost Ave, #211b, Kansas City, MO, 64110, USA

    Sarah Finocchario-Kessler

Authors
  1. Sarah Finocchario-Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. I. Bastos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Malta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Goggin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Sweat
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Dariotis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. N. Bertoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Kerrigan
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Rio Collaborative Group

Corresponding author

Correspondence to Sarah Finocchario-Kessler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Finocchario-Kessler, S., Bastos, F.I., Malta, M. et al. Discussing Childbearing with HIV-infected Women of Reproductive Age in Clinical Care: A Comparison of Brazil and the US. AIDS Behav 16, 99–107 (2012). https://doi.org/10.1007/s10461-011-9906-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-011-9906-1

Keywords

Search

Navigation