Meeting the needs of HIV-infected pregnant women requires understanding their backgrounds and potential barriers to care and safe pregnancy. Foreign-born women are more likely to have language, educational, and economic barriers to care, but may be even more likely to choose to keep a pregnancy. Data from HIV-infected pregnant women and their children in Rhode Island were analyzed to identify trends in demographics, viral control, terminations, miscarriages, timing of diagnosis, and adherence to followup. Between January 2004 and December 2009, 76 HIV-infected women became pregnant, with a total of 95 pregnancies. Seventy-nine percent of the women knew their HIV status prior to becoming pregnant. Fifty-four percent of the women were foreign-born and 38 percent of the 16 women who chose to terminate their pregnancies were foreign-born. While the number of HIV-infected women becoming pregnant has increased only slightly, the proportion that are foreign-born has been rising, from 41 percent between 2004 and 2005 to 57.5 percent between 2006 and 2009. A growing number of women are having multiple pregnancies after their HIV diagnosis, due to the strength of their desire for childbearing and the perception that HIV is a controllable illness that does not preclude the creation of a family. 1. Introduction Understanding and supporting HIV-infected women’s awareness of their own status and their options regarding pregnancy requires an understanding of their backgrounds and the potential barriers to care and safe pregnancy. Studies have shown that both social pressures and concerns for vertical transmission play a large role in HIV-infected women’s choices about pregnancy [1–3]. Information from around the world supports the fact that since the introduction of reliable methods for the prevention of mother-to-child transmission (PMTCT), fewer HIV-infected women are choosing terminations and many are choosing to become pregnant, even to have multiple pregnancies, after their HIV diagnosis [2, 4–6]. Options for safe conception, especially in serodiscordant couples, now include artificial insemination and “sperm washing” [7]. These methods, even where they are available, however, remain relatively unknown and infrequently recommended by many healthcare providers, even in developed countries [8] and may be prohibitively expensive or inaccessible for some couples. In addition to these planned pregnancies, a large number of pregnancies remain unplanned [9, 10]. Women who live in developing countries, where safer methods of conception are relatively unknown or
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