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  • Title: Influence of human immunodeficiency virus infection on reproductive decisions.
    Author: Sunderland A.
    Journal: Obstet Gynecol Clin North Am; 1990 Sep; 17(3):585-94. PubMed ID: 2247292.
    Abstract:
    This article discusses the role of the practitioner in the pregnancy decision-making process of the HIV-infected woman. Literature on women's decisions is reviewed, and variables that influence decisions are discussed. The author concludes that HIV infection does not have a significant impact on pregnancy decisions. Other cultural and psychosocial variables may have more importance. In response to the finding of human immunodeficiency virus (HIV) infection rates of 1-5% among pregnant women in areas where high-risk behaviors are widespread, the Centers for Disease Control and the American College of Obstetricians and Gynecologists are recommending that reproductive-age women at risk of HIV infection be tested. Although this policy was formulated to facilitate informed reproductive decision making, there is--at this point--little evidence that knowledge of HIV serostatus is having a significant impact on decisions about pregnancy. Data from New York City indicate that HIV-positive women become pregnant at a rate similar to that for seronegative women and are no more likely to abort. It appears that cultural and psychosocial factors exert a more important influence on decisions about pregnancy than the possibility of perinatal transmission and acceleration of the disease process in the mother. In many cases, the 50% risk of having an uninfected infant makes continuation of the pregnancy an acceptable risk. Many women are not diagnosed as HIV-seropositive until the 2nd trimester of pregnancy, when abortion is more difficult to accept as an option. Many black women equate abortion with genocide, while others oppose abortion on religious grounds. In some cultures, a woman is not considered "complete" until she has a child, and the male partner may exert significant pressure to continue with the pregnancy. Infected intravenous drug users are likely to have faulty judgment and be unable to follow through with either abortion or prenatal care. Finally, even when HIV-infected women do choose to abort, they often face barriers in obtaining services and discrimination from health care facilities. It is essential that physicians are aware of these complexities and learn more about the underlying causes of reproductive decisions on a case-by-case basis.
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