Academic journal article International Journal of Population Research

Occurrence of Pregnancies among HIV Infected Indian Women: Does Knowledge about HIV Status Make a Difference?

Academic journal article International Journal of Population Research

Occurrence of Pregnancies among HIV Infected Indian Women: Does Knowledge about HIV Status Make a Difference?

Article excerpt

Shrinivas Darak 1, 2 and Inge Hutter 1 and Sanjeevani Kulkarni 2 and Vinay Kulkarni 2 and Fanny Janssen 1, 3

Academic Editor:Jonathan Haughton

1, Population Research Centre, Faculty of Spatial Sciences, University of Groningen, 9747 AD Groningen, Netherlands 2, Prayas Health Group, Amrita Clinic, Pune, Maharashtra 411004, India 3, The Netherlands Interdisciplinary Demographic Institute, Lange Houtstraat 19, 2511 CV The Hague, Netherlands

Received 10 September 2014; Revised 12 February 2015; Accepted 16 February 2015; 24 February 2015

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

While high income countries have long maintained near universal coverage of antiretroviral treatment (ART) for pregnant women, the coverage of effective ART has also reached 68% for pregnant women in low and middle income countries in 2013 [1]. With recently launched global targets at the United Nations General Assembly, efforts would be made to diagnose 90% of all people living with HIV, treat 90% of all diagnosed people, and achieve viral suppression in 90% of all the people treated for HIV by 2020 [2]. Increased access to ART and to prevention of mother to child transmission of HIV (PMTCT) services has been hypothesized as one of the important determinants of fertility desires and behaviours [3, 4].

The relation between HIV infection and fertility is far from being straightforward. Most previous studies on the effect of HIV on pregnancy rates, conducted prior to widespread availability of antiretroviral treatment (ART), suggest reduced fertility due to HIV at population level [5, 6] and individual level [7] with an exception of a few studies that did not find any association between HIV infection and reduction in pregnancy rates [8].

There is emerging literature on fertility among HIV infected women who have access to ART. The comparison of the literature on effect of HIV on fertility from pre-ART and post-ART era yields ambiguous results. While the population level studies in the pre-ART era suggested decline in fertility due to HIV [5, 6, 9] as a result of advanced HIV disease on lowering fecundity, increasing mortality, and reduced interest or opportunities for sexual activity, a few studies also suggest that HIV may increase fertility due to reduced period of breastfeeding and desire for more children due to increased child mortality [10]. More recent studies from post-ART era showed an increase in pregnancy rate among women initiating or receiving ART [11, 12] due to restoration of fertility and sexual activity [13]. However there are also studies that reported lower pregnancy rates among HIV infected women on ART despite its beneficial effect on survival and for PMTCT [14]. There is growing research suggesting that ART might increase pregnancy desire and intention but may not increase actual incidence of pregnancies [4, 15] and the majority of the pregnancies in women on ART might be unplanned pregnancies [16-18] due to lack to effective contraception.

HIV can have biological as well as behavioural effects on reproduction among HIV infected couples. The biological effect would be the effect of the virus and the disease progression on fecundity [19, 20], that is, the physical ability of the woman to become pregnant and her ability to continue pregnancy to term. The behavioural effect is exerted through the alteration in reproductive decision making of infected couples after they become aware about their HIV status [19]. Many studies have assessed the biological and behavioural effects together [21, 22]. Most of these studies showed a decline in pregnancy rates among HIV infected women. However, it remains unclear if this decline is due to the biological effect or behavioural factors [14]. …

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