PREGNANCY AND CONTRACEPTION USE AMONG URBAN RWANDAN WOMEN AFTER HIV TESTING AND COUNSELING

Objectives. This study examined hormonal contraceptive use and pregnan cy in urban Rwandan women, following human immunodeficiency virus (HIV ) antibody testing and counseling. Methods. A sample of 1458 childbear ing urban Rwandan women aged 18 to 35 years was tested and followed fo r 2 years. Results. At enrollment, 17% of 998 HIV-negative women and 1 1% of 460 Hiv-positive women were pregnant, and 17% vs. 23%, respectiv ely, were using hormonal contraceptives. One year later, half of the H IV-positive and one third of the HIV-negative hormonal-contraceptive u sers had discontinued use. The 2-year incidence of pregnancy was 43% i n HIV-positive and 58% in HIV-negative women. HIV-positive women with fewer than four children were more likely to become pregnant than thos e with four or more; this association persisted in multivariate analys es but was not noted among HIV-negative women. At the end of the study , over 40% of non-users said that they would use hormonal contraceptio n if it was provided at the study clinic, but 40% of HIV-positive wome n desired more children. Conclusions. Research is needed to identify t he practical and psychosocial obstacles to effective long-term contrac eption among HIV-positive women. HIV counseling programs must specific ally address the issue of childbearing.