Pregnancy Intentions of HIV-Infected Women: Forwarding a Research Agenda

Harvard School Of Public Health, Boston MA

Investigators

Abstract

DESCRIPTION (provided by applicant): Abstract: The Group on Reproductive Health and Rights (GRHR), based in the Harvard Center for Population and Development Studies, proposes a three-day conference to examine the pregnancy intentions of HIV- infected women living in resource-poor countries. Research specifically on HIV-infected women and their reproductive choices has largely been based on the assumption that women, upon learning of their status, will no longer want to bear children. With the advent of increased access to ART, and with HIV researchers'growing awareness of pregnancy related issues, recent studies have begun to show that many HIV-infected women are nonetheless becoming pregnant and bearing children. Consequently, the objective of this conference is to determine existing gaps in research and to develop a multidisciplinary research agenda, spanning the biomedical and social sciences, capable of developing an effective public health response that can deliver a high quality constellation of reproductive health services to HIV-infected women. As HIV-infected women's reproductive health is still often viewed instrumentally, it is our intent that women be the primary focus of this conference. Thus some issues, but not all, that relate to men's reproductive lives will be considered. We will pinpoint areas where a solid evidence base already exists and highlight remaining gaps in current knowledge. Framed by desired and undesired pregnancy, both before pregnancy and after women have become pregnant, this approach will shape the topics to be discussed. Across these issues, the conference will explore: (1) What is the impact of HIV infection, and awareness of HIV status on the decisions women face concerning pregnancy and childbirth?;(2) How do the constellation and quality of available health services, including access to ART, affect women's intentions and opportunities?;(3) How do marital status and relationship dynamics influence fertility intentions in the context of the HIV epidemic?;and (4) How do the domains of culture, politics and economics impact on women's options regarding childbearing and management of HIV infection? Exploring these questions will provide a framework upon which to base a research agenda. Members of the Conference Steering Committee were selected based on their expertise in the field of HIV/AIDS, building on the reproductive health expertise of current GRHR members. The Organizing Committee was selected based on members'experience working in reproductive health as they relate to HIV/AIDS. The work of these committees will ensure that individuals working at the forefront of these issues will be invited to participate, with a particular focus on including women, minorities, and people with disabilities. The conference outputs will include technical papers, a conference report and papers ready for submission to peer reviewed journals including Reproductive Health Matters and The American Journal of Public Health. The pregnancy intentions of HIV-infected women are not well understood, with potentially significant impacts on both the conduct of research and effective public health programming. A conference is needed at this time to set a multidisciplinary research agenda exploring the factors affecting the reproductive decisions that HIV- infected women make. The recent NICHD RFA, Addressing the Role of Pregnancy in HIV Prevention, is an important first step.