Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study.
Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study.
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DOI：
10.1186/s12889-015-2498-3
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发表时间：
2016-01-16
影响因子：
4.5
通讯作者：
Lockman S
中科院分区：
文献类型：
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作者：
Mayondi GK;Wirth K;Morroni C;Moyo S;Ajibola G;Diseko M;Sakoi M;Magetse JD;Moabi K;Leidner J;Makhema J;Kammerer B;Lockman S
在广泛提供抗逆转录病毒治疗的时代，在艾滋病毒负担高的南部非洲环境中，艾滋病毒血清状况知识对怀孕意愿和避孕药具使用的影响知之甚少。我们分析了在博茨瓦纳南部两个地点收集的473名未感染艾滋病毒和468名感染艾滋病毒的孕妇和最近产后妇女的访谈数据。参与者接受了采访，了解他们的艾滋病毒感染状况怀孕前，怀孕的意图，避孕药具的使用，以及未来的生育愿望。941名女性的中位年龄为27岁，中位终身妊娠为2次，416例（44%）妊娠为意外妊娠。在报告意外怀孕的妇女中，36%的人在怀孕前没有使用避孕方法。在避孕药具使用者中，81%使用避孕套，13%使用口服避孕药，5%使用注射避孕药。在单变量分析中，意外怀孕的妇女有较高的怀孕次数（P = <0.0001），受教育程度较低（P = 0.0002），已婚或与伴侣生活的可能性较小（P < 0.0001）。30%的人报告说他们知道自己感染了艾滋病毒，48%的人报告说他们知道自己没有感染艾滋病毒，22%的人报告说在怀孕前不知道自己的艾滋病毒状况。在多变量分析中，与知道自己未感染艾滋病毒的妇女相比，在怀孕前不知道自己艾滋病毒状况的妇女更有可能报告自己意外怀孕（aOR = 1.7; 95%CI：1.2-2.5）。在控制了其他因素后，意外怀孕与怀孕前知道自己的艾滋病毒阳性状态无关（与怀孕前知道自己的艾滋病毒阴性状态相比）。在非预期怀孕的妇女中，在调整分析中，知道自己的艾滋病毒状况和怀孕前使用避孕药具之间没有关联。61%的妇女报告说在怀孕后不想再要孩子，与未感染艾滋病毒的妇女相比，感染艾滋病毒的妇女更有可能报告不想再要孩子（aOR = 3.9; 95%CI：2.6-5.8）。据报意外怀孕和避孕失败/滥用的比率很高，这突出表明，博茨瓦纳未感染艾滋病毒和感染艾滋病毒的妇女迫切需要更好地获得有效的避孕方法。较低的社会经济地位和缺乏孕前艾滋病毒检测可能表明在这种情况下意外怀孕的风险较高。
Little is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability. We analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires. The median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44 %) of pregnancies were unintended. Among women reporting unintended pregnancy, 36 % were not using a contraceptive method prior to conception. Among contraception users, 81 % used condoms, 13 % oral contraceptives and 5 % an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = <0.0001), were less educated (P = 0.0002), and less likely to be married or living with a partner (P < 0.0001). Thirty-percent reported knowing that they were HIV-infected, 48 % reported knowing they were HIV-uninfected, and 22 % reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one’s HIV positive status prior to conception (compared with knowing one’s negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8). The high rates of reported unintended pregnancy and contraceptive failure/misuse underscore an urgent need for better access to effective contraceptive methods for HIV-uninfected and HIV -infected women in Botswana. Lower socioeconomic status and lack of pre-conception HIV testing may indicate higher risk for unintended pregnancy in this setting.