摘要：Objectives. This study investigated the impact of HIV voluntary counseling and testing (VCT) on reproduction planning among 1634 adults in 2 sub-Saharan countries. Methods. Data were obtained from a multisite randomized controlled trial. Results. At 6 months post-VCT, the women more likely to be pregnant were younger (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.0, 6.5), not using contraceptives (OR = 0.1; 95% CI = 0.1, 0.3), and HIV infected (OR = 3.0; 95% CI = 1.3, 7.0). An interaction emerged linking pregnancy intention at baseline and HIV serostatus with pregnancy at follow-up (OR = 0.1; 95% CI = .0, 0.4) Partner pregnancy rates did not differ by HIV serostatus among men. Conclusions. HIV diagnosis may influence reproduction planning for women but not for men. The effect of an HIV diagnosis on reproduction planning in developing countries is not well understood. Clinical symptoms of disease, 1, 2 coexisting sexually transmitted infections, 3 and HIV-induced amenorrhea 4 are associated with reduced fertility. HIV infection may also result in pregnancy complications such as decreased birthweight, prematurity, and elevated risk of preterm delivery. 5 Psychosocial factors also affect reproduction planning and fertility among individuals infected with HIV, both in developed and developing countries. Pregnancy after HIV diagnosis has been associated with relationship stability, 6, 7 comorbid substance abuse, 8, 9 reduced sexual activity, 10 and decreased contraception use. 4, 11, 12 In addition, childbearing after knowledge of HIV infection has been associated with nulliparity, 1, 3, 13 lack of information about vertical transmission of HIV, 14, 15 perceived absence of clinical illness, 16 and the wish to avoid stigma, abandonment, and other repercussions of being perceived to be infected or unable to bear offspring. 13, 17, 18 Missing from many of these studies is consideration of the effect of intention to bear offspring on reproduction following HIV diagnosis. In developed countries, HIV diagnosis appears to lead many women to avoid pregnancy or to undergo pregnancy termination, 6, 7, 9 decisions that may be attributed in part to availability of and access to voluntary counseling and testing (VCT), modern contraception, and safe and legal abortion services. 3, 4 By contrast, studies in several African countries have suggested that HIV diagnosis has little effect on subsequent childbearing. 2, 11, 19 Yet, 1 limitation of these studies is that none have directly examined the effect of intention to reproduce on reproduction following HIV diagnosis. One exception, a study of HIV-infected and uninfected Rwandan women, showed that both groups expressed equally the desire for additional offspring after HIV testing, 17 suggesting that knowledge of HIV infection and intention to reproduce following diagnosis may interact to influence subsequent reproduction.
