Knowledge of HIV antibody status and decisions to continue or terminate pregnancy among intravenous drug users
P. A. Selwyn, R. J. Carter, E. E. Schoenbaum, V. J. Robertson, R. S. Klein and M. F. Rogers
Department of Epidemiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467.
We studied decisions to continue or terminate pregnancy among human
immunodeficiency virus (HIV)-seropositive (+) and -seronegative (-)
intravenous drug users informed of HIV antibody status before 24 weeks'
gestation. Fourteen (50%) of 28 HIV+ vs 16 (44%) of 36 HIV- women chose to
terminate their pregnancies. In retrospective interviews, HIV+ women were
more likely to have perceived their risk of perinatal HIV transmission to
be greater than or equal to 50% and, among those who terminated pregnancy,
to cite this concern as an important factor in their decision. However,
decisions to terminate pregnancy were predicted more readily by
pregnancy-related variables such as prior elective abortion, a negative
emotional reaction to pregnancy, and whether the pregnancy had been
unplanned. Women who were HIV+ and chose to continue their pregnancies
cited the desire for a child, religious beliefs, and family pressure as the
most important factors in their decisions. Results indicate that while
concerns about perinatal transmission of HIV may lead to decisions to
terminate pregnancy in certain cases, there may be other determinants of
pregnancy decisions in this population. Counseling of HIV-infected women
must address not only perinatal transmission but also the sociocultural and
behavioral context in which pregnancy decision making takes place.
