文章基本信息

标题：HIV and Pregnancy Intentions: Do Services Adequately Respond to Women's Needs?
本地全文：下载
作者：Sofia Gruskin ; Rebecca Firestone ; Sarah MacCarthy 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：10
页码：1746-1750
DOI：10.2105/AJPH.2008.137232
语种：English
出版社：American Public Health Association
摘要：Too little is known about how an HIV diagnosis and access to care and treatment affect women's childbearing intentions. As access to antiretroviral therapy improves, greater numbers of HIV-positive women are living longer, healthier lives, and many want to have children. Effectively supporting women's reproductive decisionmaking in the context of HIV requires understanding how pregnancy, reproduction, and HIV intersect and asking questions that bridge the biomedical and social sciences. Considering women to be at the center of decisions on health policy and service delivery can help provide an appropriate constellation of services. A clear research agenda is needed to create a more coordinated approach to policies and programs supporting the pregnancy intentions of women with HIV. THE DECISIONS WOMEN MAKE about pregnancy and childbearing are influenced by a complex interplay of factors ranging from access to health services to personal aspirations and societal norms. A diagnosis of HIV may further complicate these decisions. Open in a separate window Cherish, age 12 years, plays duck-duck-goose at Camp Heartland in Willow River, Minnesota, a camp for children affected by HIV/AIDS. Although HIV-free herself, Cherish comes to camp to seek relief from the strain of living in a family affected by AIDS. Photograph by Katja Heinemann. Printed with permission of IPNSTOCK.com. Too little is known about how an HIV diagnosis and access to HIV care and treatment affect women's intentions to bear children. As access to antiretroviral therapy improves globally, greater numbers of HIV-positive women are living longer, healthier lives. Consequently, many women with HIV face an increasing range of decisions related to pregnancy and childbearing.¹ One of the prevailing assumptions driving much public health policy and practice regarding HIV-positive women is that an HIV diagnosis will or should quell a woman's desire to have children, even as the social premium on childbearing remains.^{2 , 3} Women are left to negotiate these conflicting expectations. We highlight questions that show how considering individual women at the center of relevant policy and service delivery decisions can support the provision of an effective constellation of services for HIV-positive women. Although women are the focus of this commentary, we note that further attention to men's reproductive lives is warranted. We provide a brief review of research and policy directives linking reproductive health and HIV to date, outline some of the factors affecting women's decisionmaking in this area, and conclude by underscoring factors requiring further consideration. These observations are based on a review of the literature, discussions with women living with HIV, and participation in conferences bringing together policymakers, researchers, and others concerned with these issues. For the literature review, we conducted a critical assessment of materials from the peer-reviewed as well as gray literature on the intersections between HIV and sexual and reproductive health,^{4 – 7} and included in our assessment program documentation from international organizations (e.g., the US Agency for International Development [USAID], the Joint United Nations Programme on HIV/AIDS [UNAIDS], and the World Health Organization [WHO]). Additionally, a review was conducted of information available on relevant electronic mailing lists and newsletters focused on the intersections of HIV, reproductive health, and pregnancy.