Mirror, mirror on the wall: the face of HIV + women in Europe today

Abstract

Sexual and reproductive health (SRH) and rights are important components of quality of life. This cross-sectional study describes HIV-positive women's SRH aspirations and needs and the predictive value of selected SRH factors on condom use with steady sexual partners. Data were collected in a European multi-centre study in 17 HIV centres in 14 European countries by a standardised anonymous self-administered questionnaire. Descriptive statistics and hierarchical regression analysis were carried out and qualitative data from related formative research illustrated the findings.

Among 387 HIV-positive women, 57% had children and 35% had become pregnant since their HIV-diagnosis. Contraceptive needs were largely unmet: 14% had undergone a pregnancy termination. About 83% changed their sexual behaviour after HIV-diagnosis in some ways. Sixty-two percent had at least one sexual encounter with a steady partner during the past six months and 51% used condoms consistently. Significant correlations with condom use were identified for childbearing since HIV-diagnosis (r=−0.21, p<0.01), miscarriage since HIV-diagnosis (r=−0.24, p<0.01), the use of contraception (r=0.47, p<0.001) and changes in sexual behaviour after HIV-diagnosis (r=0.20, p<0.01). Hierarchical regression analysis controlled for education, migration background, age, undetectable viral load and partners' serostatus. The following significant predictors for condom use were established: the use of contraceptives (β=0.33, p<0.001); miscarriage since HIV-diagnosis (β=−0.16, p<0.01); childbearing since HIV-diagnosis (β=−0.12, p<0.05); and having an HIV-positive partner (β=−0.13, p<0.05). For study population, consistent condom use performed a challenge. Selected SRH-issues predicted condom use. Sexual risk reduction and positive prevention should be discussed in the context of family planning and integrate SRH perspectives in routine HIV care.

Keywords:

• HIV
• women
• sexual and reproductive health
• prevention
• condom use

Acknowledgements

We are grateful to all study participants for contributing to this study and to the investigators at the participating centres: Austria: Birgit Mumelter (University of Innsbruck), Gabriele Schmied (European Centre, Vienna); Belgium: Ruth Borm, Koen Block (Sensoa, Antwerp); Lut Lynen, Eric Florence (Institute of Tropical Medicine, Antwerp); Czech Republic: Ivo Prochazka (University of Prague); Germany: Johannes Bogner, Matthias Müller (Ludwig Maximilians University, Munich), Werner Becker, Ramona Volkert (Private Practice, Munich), Andreas Niedermeier (University Clinic for Dermatology, Munich), Martin Karwat (Private Practice, Munich); Greece: Nikos Dedes (Synthesis, Athens); Hungary: Peter Csépe (Semmelweis University, Budapest); Italy: Gloriana Bartoli, Carlo Giaquinto (University of Padua, Padua); Caterina Uberti-Foppa, Giulia Gallotta (HSR Ospedale, Milan); Latvia: Anda Vaisla (Latvian Family Planning Association, Riga); Poland: Michal Pozdal, Zbigniew Izdebski (University of Zielona Góra); Portugal: Luis Caldeira (Hospital Santa Maria, Lisbon); Slovak Republic: Danica Stanekova (Slovak Medical University); Spain: Victoria Gordillo (University Complutense of Madrid); Switzerland: Daniel Gredig (University of Applied Sciences of North-Western Switzerland); United Kingdom: Ed Wilkins and Cinthia Murphy (Pennine Acute Hospitals NHS Trust, Manchester).

Our thanks go also to the Swiss National Science Foundation and the Swiss HIV Cohort Study for funding, support and cooperation.