Differences and similarities in women living and not living with HIV: contributions by the GENIH study to sexual and reproductive healthcare

Pinho, Adriana de Araujo; Cabral, Cristiane da Silva; Barbosa, Regina Maria

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ARTICLE • Cad. Saúde Pública 33 (12) • 2017 • https://doi.org/10.1590/0102-311X00057916 copy

Differences and similarities in women living and not living with HIV: contributions by the GENIH study to sexual and reproductive healthcare

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

This quantitative study in the city of São Paulo, Brazil, compared contexts of social vulnerability and sexual and reproductive behavior in a sample of 975 women living with HIV/AIDS (WLHIV) and 1,003 women not living with HIV, the latter recruited among users of the primary healthcare system. WLHIV experienced situations of greater vulnerability that potentially increased their risk of HIV infection and unplanned pregnancy and abortion. Compared to women users of the primary healthcare system, WLHIV reported higher rates of drug use, sex for money, exposure to intimate partner violence, difficulties in access to services for prevention and early diagnosis, unplanned pregnancies, induced abortion, and teenage pregnancy. A considerable number of the women users of the primary healthcare system shared these same experiences, but at lower rates. The identification of contexts of vulnerability and the integration of HIV testing services with sexual and reproductive health services should constitute lines of care for these women, both in specialized and primary care services.

Keywords:
HIV; Sexual and Reproductive Health; Women

	WLHIV		Women of the primary healthcare system		p-value
	n *	% **	n *	% **
Age bracket (years)
Median (years) (IQR)	40 (34-45)		31 (24-39)
18-24	42	4.5	257	26.3	< 0.0001
25-34	71	8.0	175	17.7
35-44	320	35.2	315	31.5
45-49	485	52.3	256	24.5
Schooling
Incomplete primary	247	27.0	204	20.2	0.0001
Complete Primary/Incomplete Secondary	234	25.3	247	24.8
Complete Secondary	294	31.9	491	48.9
University (complete or incomplete)	143	15.7	60	6.0
Skin color
White	373	40.1	391	39.1	< 0.0001
Black	158	18.0	107	10.7
Brown	368	40.4	473	47.1
Other (Asian/Indigenous)	16	1.6	31	3.0
Currently working
Yes	515	56.4	601	58.8	0.397
No	396	43.5	399	41.1
Currently or previously married or in stable union	840	92.1	846	84.2	< 0.0001
Number of living children
None	162	17.5	319	32.0	< 0.0001
1	261	28.8	267	27.0
2 or more	495	53.7	417	41.0
Total	918	100.0	1,003	100.0

	n *	% **
Transmission route
Sexual	814	90.5
Injecting drug use	-	-
Vertical	-	-
Blood transfusion	25	2.9
Other	25	2.7
Does not know	35	3.8
Age at diagnosis (years)
18-24	255	28.0
25-34	469	52.0
35-49	181	19.6
Does not know or remenber	4	0.4
Median age (IQR)	28	(24-33)
Time since diagnosis (years)
≤ 1	83	8.9
2-5	181	20.6
6-10	214	24.7
More than 10	408	45.7
Median time	10	(0-28)
Reason for HIV testing ***
During prenatal care of childbirth	282	31.1
Physician ordered (outside prenatal/childbirth)	78	8.5
Own initiative	95	10.8
Partner or children became ill	240	26.4
Person herself became ill	205	22.6
Other	1	0.1
Total	918	100.0

	WLHIV			Women of the primary healthcare system			p-value
	n *	% **	% adjusted ***	n *	% **	% adjusted ***
Age at sexual initiation (years)							< 0.0001
≤15	319	34.9	38.5	296	30.7	27.5
> 15	589	65.1	61.5	701	69.3	72.5
First pregnancy before 20 years of age	444	57.7	58.5	421	49.8	48.9	0.001
Lifetime partners							< 0.0001
1-2	141	15.7	16.7	463	46.1	46.0
More than 2	763	84.3	84.1	533	53.9	54.2
Currently married/with partner							< 0.0001
Yes	620	67.6	69.8	862	86.2	84.8
No	298	32.4	30.2	139	13.8	15.2
Number of lifetime partners resulting in pregnancy
1	404	49.8	53.0	615	72.0	69.2	< 0.0001
2 or more	412	50.2	46.9	231	27.9	30.7
Number of partners resulting in pregnancy before HIV diagnosis (n = 765)
1	456	59.8	62.9	-	-	-	0.018
2 or more	308	40.2	37.1	-	-	-
Number of partners resulting in pregnancy after HIV diagnosis (n = 308)
1	265	91.0	91.9	-	-	-	< 0.0001 ^#
2 or more	25	8.9	8.0	-	-	-
Contraception use ^##
Current (n = 585; n = 533)	546	85.0	83.4	486	73.0	73.8	< 0.0001
At time of diagnosis (n = 940)	286	48.7	47.8	-	-	-	< 0.0001 ^#
Always uses condoms during vaginal sex ^###
Currently (n = 731; n = 934)	470	69.1	69.3	154	16.1	15.9	< 0.0001
At time of diagnosis (n = 862)	84	10.2	10.5	-	-	-	0.007 ^#
Proportion of unplanned pregnancies (all or more than half)
Lifetime	526	64.3	63.8	455	54.0	54.7	< 0.0001
Before HIV/diagnosis during pregnancy (n = 765)	496	64.5	64.0	-	-	-	< 0.0001 ^#
Since HIV diagnosis (n = 308)	194	66.9	66.3	-	-	-	< 0.0001 ^#
History of abortion ^§
Lifetime	116	14.1	11.9	29	3.2	3.0	0.0001
Before HIV diagnosis (n = 679)	102	14.9	15.8	-	-	-	< 0.0001 ^#
Since HIV diagnosis (n = 308)	24	5.3	6.1	-	-	-	0.032 ^#

	WLHIV			Women of the primary healthcare system			p-value
	n *	% **	% adjusted ***	n *	% **	% adjusted ***
Lifetime drug use	222	26.8	29.3	124	13.5	12.1	< 0.0001
Current or former drug-using partner	479	59.5	61.0	268	29.0	27.7	< 0.0001
Lifetime history of sex for money	64	7.5	7.9	12	1.3	1.3	< 0.0001
Lifetime history of physical violence	394	47.1	45.5	330	35.5	36.8	0.003
Lifetime history of intimate partner violence	256	30.7	28.7	180	19.5	21.1	0.005
Forced first sexual relations	72	7.7	6.8	26	2.5	2.8	< 0.0001
Lifetime sexual violence	187	21.4	19.8	89	9.3	10.2	< 0.0001
Lifetime intimate partner sexual violence	99	11.4	10.2	57	6.3	7.1	0.056

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[1] * Correspondence A. A. Pinho Laboratório de Educação em Ambiente e Saúde, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz. Av. Brasil 4365, Pavilhão Lauro Travassos, Rio de Janeiro, RJ 21040-360, Brazil. adrianaapinho@gmail.com