Pregnancy and Parenting
Whether intentionally or not, many young HIV-infected women become pregnant. Several factors influence pregnancy decisions among young women with HIV.
- With the rate of vertical transmission now quite low, partially as a result of the implementation of protocols for the prevention of mother-to-child transmission (PMTCT) of HIV, the fear of infecting a baby is no longer a deterrent for many HIV-infected women. Current estimates are that only 140 children perinatally infected with HIV are born in the United States annually.7
- Treatment advances have extended life expectancies for HIV-infected patients and improved their quality of life. Now that HIV is no longer perceived as a death sentence, many infected women choose to start families. In fact, some will start families sooner than they otherwise would, hoping to bear and raise children while they are still relatively healthy.
- For some HIV-infected women, becoming a mother represents a chance to overcome their mortality, or to "cheat death." Leaving behind a baby when they die would be a way to leave a piece of themselves--a legacy.
- Within the broader American culture as well as among many racial/ethnic groups, there is a distinct value of pregnancy and childbearing. The emphasis on and availability of infertility treatments attests to this value. Within Black/African American, Latino, AI/AN, and AA/PI communities, family and children are very important. Thus, it is likely that HIV-infected young people within these groups will want to give birth to their own children.
Assess patients' attitudes about parenting and pregnancy, using nonjudgmental questions and active listening. Sample questions are:
- "Do you see yourself having children one day?"
- "How would pregnancy and parenthood affect your life? Your current relationship?"
- "What would you do if you (or your partner) became pregnant?"
- "How do you think your parents (or caregivers) would feel or react if you (or your partner) became pregnant?"
The last question helps identify the choice of pregnancy as a vehicle for rebellion from parents, or possibly as a kind of favor to the parents, to give them a new or substitute baby.
For teens expressing interest (or even ambivalence) regarding pregnancy and childbearing, educate about reproductive choices for HIV-infected and serodiscordant couples (eg, artificial insemination, sperm washing, adoption) and provide preconception counseling.
- Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2006.