Risk and preventing perinatal HIV transmission: uncovering the social organisation of prenatal care for women living with HIV in Ontario, Canada

2020 ◽  
Vol 22 (2) ◽  
pp. 136-155
Author(s):  
Allyson Ion ◽  
Saara Greene ◽  
Christina Sinding ◽  
Daniel Grace
Keyword(s):  
Prenatal Care ◽  
Hiv Transmission ◽  
Social Organisation ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
The Social ◽  
Living With Hiv

HIV in pregnant women and prevention of perinatal transmission

2015 ◽  
Vol 36 (4) ◽  
pp. 182
Author(s):  
Michelle Giles
Keyword(s):  
Hiv Transmission ◽  
Reproductive Rights ◽  
Post Partum ◽  
Undetectable Viral Load ◽  
Perinatal Transmission ◽  
Access To Treatment ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
Uninfected Infant ◽  
Living With Hiv

Women with HIV who have access to treatment can expect to have a normal life expectancy. With effective antiretroviral therapy, an undetectable viral load, and avoidance of breastfeeding, the rate of perinatal transmission is extremely low (<1%). A Caesarean section is no longer routinely recommended nor is intrapartum zidovudine. Women living with HIV should be supported in their decision regarding parenthood given their excellent prognosis, low risk of perinatal transmission and reproductive rights. If interventions to reduce perinatal HIV transmission during pregnancy and post-partum are embraced, women can expect to have an uninfected infant.

scholarly journals Breastfeeding with HIV: An Evidence-Based Case for New Policy

2019 ◽  
Vol 47 (1) ◽  
pp. 152-160 ◽  
Author(s):  
Marielle S. Gross ◽  
Holly A. Taylor ◽  
Cecilia Tomori ◽  
Jenell S. Coleman
Keyword(s):  
Viral Load ◽  
Harm Reduction ◽  
Hiv Transmission ◽  
Undetectable Viral Load ◽  
Perinatal Transmission ◽  
Sudden Infant ◽  
National Guidelines ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
Living With Hiv

To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy (cART) status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities.

scholarly journals Preconception and Contraceptive Care for Women Living with HIV

2012 ◽  
Vol 2012 ◽  
pp. 1-14 ◽  
Author(s):  
Mary Jo Hoyt ◽  
Deborah S. Storm ◽  
Erika Aaron ◽  
Jean Anderson
Keyword(s):  
Hiv Transmission ◽  
Unmet Need ◽  
Reproductive Age ◽  
Fertility Desires ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
Specialized Care ◽  
Fertility Data ◽  
Primary Focus ◽  
Living With Hiv

Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.

scholarly journals Patterns of changing pregnancy intentions among women living with HIV in Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lashanda Skerritt ◽  
Angela Kaida ◽  
Nadia O’Brien ◽  
Ann N. Burchell ◽  
Gillian Bartlett ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Healthcare Providers ◽  
Undetectable Viral Load ◽  
Subsequent Pregnancy ◽  
Reproductive Age ◽  
Pregnancy Intentions ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Health Cohort Study

Abstract Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.

Antiretroviral Therapy in Pregnant Women

2019 ◽  
pp. 281-286
Author(s):  
William R. Short ◽  
Jason J. Schafer
Keyword(s):  
Clinical Trials ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Pediatric Aids ◽  
Women Living With Hiv ◽  
Pivotal Study ◽  
Aids Clinical Trials ◽  
Living With Hiv ◽  
Mother To Child ◽  
Over Time

Upon completion of this chapter, the reader should be able to describe the appropriate management of antiretrovirals for pregnant women living with HIV. Over time, research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission (MTCT) of HIV. In 1994, a pivotal study in the field of HIV medicine, the Pediatric AIDS Clinical Trials Group 076, demonstrated that the use of zidovudine (ZDV) monotherapy during pregnancy substantially reduced the risk of HIV transmission to infants by 67% (...

scholarly journals HIV Status and Contraceptive Utilization among Women in Cameroon

2019 ◽  
Vol 18 ◽  
pp. 232595821982659 ◽  
Author(s):  
Henna Budhwani ◽  
Kristine Ria Hearld ◽  
Jodie Dionne-Odom ◽  
Simon Manga ◽  
Kathleen Nulah ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Hiv Transmission ◽  
Multivariate Analyses ◽  
Hiv Status ◽  
Improve Population Health ◽  
Women Living With Hiv ◽  
Contraceptive Utilization ◽  
Living With Hiv ◽  
Mother To Child ◽  
Hiv Negative

Objective: We examined patterns of contraceptive utilization by HIV status among women in Cameroon, hypothesizing that women living with HIV would utilize contraception at higher rates than their HIV-negative peers. Methods: Deidentified, clinical data from the Cameroon Baptist Convention Health Services (2007-2013) were analyzed (N = 8995). Frequencies compared outcomes between women living with HIV (15.1%) and uninfected women. Multivariate analyses examined associates of contraceptive utilization and desire to become pregnant. Results: Contraceptive utilization was associated with higher education, living with HIV, monogamy, and higher parity ( P < .001). Women living with HIV had 66% higher odds of using contraceptives than their negative peers (odds ratio [OR]: 1.66, confidence interval [CI]: 1.45-1.91, P < .001). Polygamous women had 37% lower odds of using contraceptives compared to monogamous women (OR: 0.63, 95% CI: 0.52-0.75, P < .001). Conclusion: Increasing contraceptive utilization in resource-constrained settings should be a priority for clinicians and researchers. Doing so could improve population health by reducing HIV transmission between partners and from mother to child.

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