Mbarara University of Science and Technology, Mbarara, Uganda.
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
AIDS Behav. 2019 Jun;23(6):1552-1560. doi: 10.1007/s10461-018-2317-9.
Comprehensive HIV treatment and care makes it safer for women living with HIV (WLWH) to have the children they desire, partly through provision and appropriate use of effective contraception. However, nearly one third of WLWH in-care in a large Ugandan cohort became pregnant within 3 years of initiating ART and half of these incident pregnancies (45%) were unplanned. We therefore describe future pregnancy plans and associated factors among postpartum WLWH in rural southwestern Uganda in order to inform interventions promoting postpartum contraceptive uptake. This analysis includes baseline data collected from adult WLWH enrolled into a randomized controlled trial to evaluate the effect of family planning support versus standard of care at 12 months postpartum in southwestern Uganda. Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrolment. Among 320 enrolled women, mean age, CD4 count, and duration on ART was 28.9 (standard deviation [SD] 5.8) years, 395 cells/mm (SD = 62) and 4.6 years (SD = 3.9), respectively. One-hundred and eighty nine (59%) of women reported either personal (175, 55%) or partner (186, 58%) desire for more children in the next 2 years. Intentions to have more children was strongly associated with partner's desire for more children (AOR = 31.36; P < 0.000), referent pregnancy planned (AOR = 2.69; P = 0.050) and higher household income > 150,000 Shs per month (AOR = 1.37; P = 0.010). Previous use of modern contraception (AOR = 0.07; P = 0.001), increasing age (AOR = 0.34; P = 0.012), having > 2 own children living in a household (AOR = 0.42; P = 0.021) and parity > 2 (AOR = 0.59; P = 0.015) were associated with reduced odds of pregnancy intention. Our findings highlight the role male partners play in influencing pregnancy intentions postpartum and the importance of engaging men in sexual and reproductive health counselling about child spacing for the health of women, children, and families. This should be addressed alongside key individual-level social, demographic, economic and structural factors within which couples can understand risks of unplanned pregnancies and access effective contraceptive methods when they need or want them.
全面的艾滋病毒治疗和护理使艾滋病毒感染者（WHIV）更容易生育她们想要的孩子，部分原因是提供和适当使用有效的避孕措施。然而，在乌干达一个大型队列中，近三分之一的接受抗逆转录病毒治疗的 WHIV 在开始接受抗逆转录病毒治疗后 3 年内怀孕，而这些偶发妊娠中有一半（45%）是无计划的。因此，我们描述了乌干达西南部农村地区产后 WHIV 的未来妊娠计划及其相关因素，以便为促进产后避孕措施的使用提供信息。这项分析包括从参加一项随机对照试验的成年 WHIV 中收集的基线数据，以评估在乌干达西南部产后 12 个月时计划生育支持与标准护理的效果。参加试验的产后 WHIV 在入组时完成了由调查员进行的问卷调查。在 320 名入组的女性中，平均年龄、CD4 计数和抗逆转录病毒治疗时间分别为 28.9（标准差[SD]为 5.8）岁、395 个细胞/mm（SD=62）和 4.6 年（SD=3.9）。189 名（59%）女性报告说，在未来 2 年内，她们个人（175 名，55%）或伴侣（186 名，58%）都希望再要孩子。想要更多孩子的意愿与伴侣想要更多孩子的意愿强烈相关（比值比[OR]=31.36；P<0.000）、参考妊娠计划（OR=2.69；P=0.050）和更高的家庭收入（每月>150000 先令）（OR=1.37；P=0.010）。以前使用现代避孕方法（OR=0.07；P=0.001）、年龄增长（OR=0.34；P=0.012）、家中有>2 个自己的孩子（OR=0.42；P=0.021）和产次>2（OR=0.59；P=0.015）与妊娠意愿降低有关。我们的研究结果突出了男性伴侣在产后妊娠意愿方面所起的作用，以及让男性参与性和生殖健康咨询，以了解生育间隔对妇女、儿童和家庭健康的重要性。这应该与夫妇能够理解意外怀孕风险并在需要或想要时获得有效避孕方法的关键个人层面的社会、人口、经济和结构因素一起解决。
