Fewer than a third discuss contraception
Researchers who looked at the medical records of 128 women with the human immunodeficiency virus (HIV) found that fewer than a third discussed contraception with their doctors. Sexual activity status was only documented for about half of the women.
"The issue is that many HIV doctors are infectious diseases specialists not trained in women's health," said Dr. Mona Loutfy, director of the Women and HIV Research Programme at Women's College Hospital in Toronto.
"Also, many HIV doctors only talk about HIV-related items during the visit and not issues related to women's (health) and reproductive health," said Loutfy, who was not part of the study.
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"The authors and researchers like me are advocating for HIV doctors to add these items – including contraception and pregnancy planning – to the routine HIV visits," she told Reuters Health by email.
Worldwide, unintended pregnancy rates are as high as 50 to 84 percent among women with HIV, according to a report of the new study in the Journal of Family Planning and Reproductive Health Care.
For the new study, researchers from Monash University and Monash Health in Clayton, Australia, looked at the records of women ages 16 to 49 who were treated for HIV between 2010 and 2012 at two city hospitals in Melbourne. More than 80 percent of women were on antiretroviral therapy, which is used to stop the virus from replicating.
The medical records showed that doctors discussed the women's sexual activity in 54 percent of cases, and relationship status in 76 percent of cases. About a third of the women had contraceptive discussions recorded in their records.
Women who discussed sexual activity with their doctors were more than three times as likely to use contraception as others.
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Neither patient age, pregnancy history nor doctor gender was tied to discussions about sexual activity.
Eleven women were considering pregnancy or actively trying to conceive, the researchers found.
HIV-positive women should discuss pregnancy plans before getting pregnant, because they will need to start taking folic acid and confirm their low viral load and ideal antiretroviral therapy, Loutfy said.
Transmission rate 25 percent without treatment
Antiretroviral therapy during pregnancy can reduce the HIV transmission rate from mother to baby to 2 percent or less, but without treatment the transmission rate is 25 percent, CDC spokesperson Nikki Mayes told Reuters Health in a statement.
As for contraception, recommendations are the same for both HIV-positive and negative women, Loutfy said. Those are to use hormonal contraception to prevent pregnancy as well as condoms to prevent sexually transmitted infections.
Additionally, HIV-positive women need to discuss potential drug interactions between their antiretroviral therapies and contraceptive medications, she said.
HIV-positive women should also see a provider for a yearly Pap smear, which is more frequent than for other women due to the higher risk of human papillomavirus (HPV) infection and cervical cancer, Loutfy said.
Image: Doctor with female patient from Shutterstock