Counselling about pregnancy-related issues
There are several issues to be addressed when counselling HIV
positive pregnant women, in addition to the general issues related to HIV
infection. These include information about the interactions of HIV and
pregnancy, options of termination of pregnancy, discussion about disclosure to
the male partner, the risk of mother-to-child transmission and possible
interventions to prevent this, other treatment options, infant feeding and HIV
and future fertility. Some of these pregnancy-related issues are detailed in
Table 7.
Table 7 : Issues in counselling HIV-positive pregnant
women
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The effect of pregnancy on HIV infection
The effect of HIV
infection on pregnancy outcome: risks of adverse pregnancy events
The risk of
transmission to the fetus during pregnancy, delivery and
breastfeeding
Termination of pregnancy options
Treatment options during
pregnancy
Interventions available to attempt to prevent mother-to-child
transmission
Infant feeding options: the advantages and disadvantages of
breastfeeding
Disclosure of results to male partners and/or to other
significant family or community members: advantages and risks
The need for
follow-up of both mother and child
Future fertility and contraceptive options
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HIV-infected women should be given appropriate information to
make informed decisions about the continuation of their pregnancy and future
fertility348. Termination of pregnancy should be offered to HIV
positive women; where this is legal. It should be clear to health care workers
that offering termination should never be coercive and that all women,
irrespective of their HIV status, have the right to determine the course of
their reproductive life. Although there are some reports of increased rates of
termination in HIV positive women, the majority of women will elect to continue
with the pregnancy249,349,350,351. Knowledge of HIV infection had
little effect on reproductive trends and the decision on future children in a
number of studies248,352,353,354 although this has been seen more in
developing countries than developed countries. However, a family planning
intervention in Rwanda, providing access to and information about
contraceptives, showed a reduction in subsequent pregnancies which was greater
than in HIV-negative women355, and other studies have shown a
reduction in the number of pregnancies in HIV positive
women349,356,357,358.
