King R, Estey J, Allen S, Kegeles S, Wolf W, Valentine C, Serufilira A
Department of Epidemiology and Biostatistics, UCSF, USA.
AIDS. 1995 Jul;9 Suppl 1:S45-51.
Since contraception is an effective way of preventing the vertical transmission of HIV, we evaluated the impact of a family planning intervention on hormonal contraceptive use and incident pregnancy in a group of HIV-positive and HIV-negative urban Rwandan women.
In a longitudinal cohort study, 502 women who were not pregnant or infertile and who had been previously HIV tested and counseled viewed an informational video about hormonal contraception followed by a facilitated discussion. They were given access to oral or injectable hormonal contraception and Norplant at the research clinic; those who used these methods were seen every 3 months.
Of the 330 HIV-positive and 172 HIV-negative women who underwent the intervention, 120 either became new hormonal method users (n = 40), continued their previous use of a hormonal method (n = 64), or switched to another hormonal method (n = 16) following the intervention. There was a shift to use of longer lasting hormonal methods, and the annualized attrition rate was < 15%, compared to > 50% prior to the intervention. Rates of oral and injectable contraceptive use were similar among HIV-positive and HIV-negative women. Nine per cent of HIV-positive women became pregnant in the year after the intervention compared to 22% in a prior 12 month period when contraceptives were not provided at the study site. The corresponding proportions for HIV-negative women were 20% after the intervention versus 30% before the intervention.
Access to and information about hormonal contraceptives resulted in increased use and reduced attrition among both HIV-positive and HIV-negative women in this study. The reduction in incident pregnancy was greatest among HIV-positive women, suggesting that factors other than access to hormonal contraceptives may have influenced fertility outcomes. Knowledge of HIV serostatus may have an important influence on family planning decisions.
由于避孕是预防艾滋病毒垂直传播的有效方法，我们评估了一项计划生育干预措施对卢旺达城市地区一组艾滋病毒阳性和阴性妇女使用激素避孕方法及意外怀孕情况的影响。
在一项纵向队列研究中，502名未怀孕或未患不孕症且之前已接受艾滋病毒检测和咨询的妇女观看了一段关于激素避孕的信息视频，随后进行了一场引导式讨论。她们可在研究诊所获取口服或注射用激素避孕药物以及皮下埋植剂；使用这些方法的妇女每3个月接受一次随访。
在接受干预的330名艾滋病毒阳性妇女和172名艾滋病毒阴性妇女中，有120人在干预后成为新的激素避孕方法使用者（n = 40）、继续使用之前的激素避孕方法（n = 64）或改用另一种激素避孕方法（n = 16）。出现了向使用长效激素避孕方法的转变，年化脱落率低于15%，而干预前这一比例超过50%。艾滋病毒阳性和阴性妇女中口服和注射避孕药物的使用率相似。干预后，9%的艾滋病毒阳性妇女意外怀孕，而在研究地点之前未提供避孕措施的12个月期间，这一比例为22%。艾滋病毒阴性妇女相应的比例在干预后为20%，干预前为30%。
在本研究中，获取激素避孕药物及相关信息使得艾滋病毒阳性和阴性妇女对其使用增加且脱落率降低。艾滋病毒阳性妇女意外怀孕率下降幅度最大，这表明除了获取激素避孕药物之外的其他因素可能影响了生育结果。艾滋病毒血清学状态的知晓情况可能对计划生育决策有重要影响。
