Allen S, Serufilira A, Gruber V, Kegeles S, Van de Perre P, Carael M, Coates T J
Center for AIDS Prevention Studies, Division of General Internal Medicine, University of California, San Francisco.
Am J Public Health. 1993 May;83(5):705-10. doi: 10.2105/ajph.83.5.705.
This study examined hormonal contraceptive use and pregnancy in urban Rwandan women, following human immunodeficiency virus (HIV) antibody testing and counseling.
A sample of 1458 childbearing urban Rwandan women aged 18 to 35 years was tested and followed for 2 years.
At enrollment, 17% of 998 HIV-negative women and 11% of 460 HIV-positive women were pregnant, and 17% vs 23%, respectively, were using hormonal contraceptives. One year later, half of the HIV-positive and one third of the HIV-negative hormonal-contraceptive users had discontinued use. The 2-year incidence of pregnancy was 43% in HIV-positive and 58% in HIV-negative women. HIV-positive women with fewer than four children were more likely to become pregnant than those with four or more; this association persisted in multivariate analyses but was not noted among HIV-negative women. At the end of the study, over 40% of non-users said that they would use hormonal contraception if it was provided at the study clinic, but 40% of HIV-positive women desired more children.
Research is needed to identify the practical and psychosocial obstacles to effective long-term contraception among HIV-positive women. HIV counseling programs must specifically address the issue of childbearing.
本研究在卢旺达城市女性进行人类免疫缺陷病毒（HIV）抗体检测和咨询后，调查其激素避孕措施的使用情况及妊娠情况。
选取1458名年龄在18至35岁的卢旺达城市育龄妇女作为样本，进行检测并随访2年。
入组时，998名HIV阴性女性中有17%怀孕，460名HIV阳性女性中有11%怀孕；分别有17%和23%的女性正在使用激素避孕措施。一年后，HIV阳性激素避孕措施使用者中有一半停止使用，HIV阴性使用者中有三分之一停止使用。HIV阳性女性的2年妊娠发生率为43%，HIV阴性女性为58%。子女少于4个的HIV阳性女性比子女为4个或更多的女性更易怀孕；这种关联在多变量分析中持续存在，但在HIV阴性女性中未观察到。研究结束时，超过40%的未使用者表示，如果研究诊所提供激素避孕措施，她们会使用，但40%的HIV阳性女性希望生育更多子女。
需要开展研究，以确定HIV阳性女性有效长期避孕的实际和心理社会障碍。HIV咨询项目必须特别关注生育问题。
