Darak Shrinivas, Mills Melinda, Kulkarni Vinay, Kulkarni Sanjeevani, Hutter Inge, Janssen Fanny
Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands; PRAYAS Health Group, Pune, Maharashtra, India.
Department of Sociology, Nuffield College, University of Oxford, Oxford, England.
PLoS One. 2015 Apr 23;10(4):e0124537. doi: 10.1371/journal.pone.0124537. eCollection 2015.
HIV infection closely relates to and deeply affects the reproductive career of those infected. However, little is known about the reproductive career trajectories, specifically the interaction of the timing of HIV diagnosis with the timing and sequencing of reproductive events among HIV infected women. This is the first study to describe and typify this interaction.
Retrospective calendar data of ever married HIV infected women aged 15-45 attending a HIV clinic in Pune, Maharashtra, Western India (N=622) on reproductive events such as marriage, cohabitation with the partner, use of contraception, pregnancy, childbirth and HIV diagnosis were analyzed using sequence analysis and multinomial logistic regression.
Optimal matching revealed three distinct trajectories: 1) HIV diagnosis concurrent with childbearing (40.7%), 2) HIV diagnosis after childbearing (32.1%), and 3) HIV diagnosis after husband's death (27.2%). Multinomial logistic regression (trajectory 1 = baseline) showed that women who got married before the age of 21 years and who had no or primary level education had a significantly higher risk of knowing their HIV status either after childbearing or close to their husband's death. The risk of HIV diagnosis after husband's death was also higher among rural women and those who were diagnosed before 2005.
Three distinct patterns of interaction of timing of HIV diagnosis with timing and sequencing of events in the reproductive career were observed that have clear implications for (i) understanding of the individual life planning process in the context of HIV, (ii) formulation of assumptions for estimating HIV infected women in need of PMTCT services, and (iii) provision of care services.
艾滋病毒感染与感染者的生殖历程密切相关且影响深远。然而，对于生殖历程轨迹，尤其是艾滋病毒感染女性中艾滋病毒诊断时间与生殖事件时间及顺序之间的相互作用，我们知之甚少。这是第一项描述并归纳这种相互作用的研究。
对印度西部马哈拉施特拉邦浦那一家艾滋病毒诊所的622名年龄在15至45岁之间的已婚艾滋病毒感染女性的回顾性日历数据进行分析，这些数据涉及婚姻、与伴侣同居、使用避孕措施、怀孕、分娩及艾滋病毒诊断等生殖事件，分析方法包括序列分析和多项逻辑回归。
最佳匹配显示出三种不同轨迹：1）艾滋病毒诊断与生育同时发生（40.7%），2）生育后艾滋病毒诊断（32.1%），3）丈夫死亡后艾滋病毒诊断（27.2%）。多项逻辑回归（轨迹1为基线）显示，21岁之前结婚且未接受教育或仅接受过小学教育的女性，在生育后或接近丈夫死亡时知晓自己艾滋病毒感染状况的风险显著更高。农村女性以及2005年之前被诊断出感染艾滋病毒的女性，在丈夫死亡后被诊断出感染艾滋病毒的风险也更高。
观察到艾滋病毒诊断时间与生殖历程中事件的时间及顺序之间存在三种不同的相互作用模式，这对以下方面具有明确意义：（i）在艾滋病毒背景下理解个人生活规划过程，（ii）为估计需要预防母婴传播服务的艾滋病毒感染女性制定假设，以及（iii）提供护理服务。
