The African HIV + women are nearly three times more often a desire to have children

HIV-positive women to the AIDS virus (HIV +), from North Africa and sub-Saharan Africa, nearly three times more often want to have a child in relation to French women, experts said.
Ethnicity and HIV
They spoke at a day on "Migrants and HIV" organized a seminar of the National Agency for Research on AIDS and Viral Hepatitis (ANRS).

Since the advent of HAART (highly active antiretroviral therapy), the number of births among HIV-positive women has increased in France, mainly in Paris, according to the French ANRS perinatal survey.

According to the survey of 607 HIV-positive women in 2003, whose results were presented at the 7th Seminar of Clinical Research HIV infection, pregnancy in two gives rise to an abortion (abortion) .

Furthermore, "only one in three HIV-positive woman of childbearing age (30%) has a desire to have children," said Isabelle Heard, the Georges Pompidou European Hospital.

Factors influencing the desire for children are of different types: the fact of living in a couple, do not have children yet, to be active or seeking employment.

Finally, ethnicity plays an important role as women born in sub-Saharan Africa are 2.5 times more likely, and those born in North Africa three times, desiring pregnancy.

Also according to the survey, a woman born in France on 5 wants a child but the proportion rises to 40% among African women and 50% among women born in the Maghreb.

Among HIV-positive women who gave birth in 2001, half were born in sub-Saharan Africa and this proportion increases, explained Laurent Mandelbrot, obstetrician and gynecologist at Louis Mourier Hospital in Colombes.

The immune status does not determine the parental project
No parameters related to infection is critical in this parental project or the duration of infection or viral load.

"These are the classic determinants (age, living with a partner) that play a role, the rest does not matter," concludes Isabelle Heard.

If we look at women who have had a child when they knew their status, the proportion of African women is higher. In 2001, the incidence of pregnancy before diagnosis was 15.5% and 20.7% after diagnosis in women of African descent, against 11.2% and 6.9% respectively among European women, reminded Laurent Mandelbrot.

"The approach to motherhood and desire of pregnancy is different," says Laurent Mandelbrot. However, he says, "These women are very, very anxious COMPLIANT vis-à-vis the risk of mother to child transmission."

Despite this, the rate of mother to child transmission remains high (1% to 2%) and is higher among women of African descent, although this trend is not statistically significant.

The reason is unknown. "Contrary to what is said, African women are more reluctant to caesarean section and it is not more difficult for them not to breastfeed," says Laurent Mandelbrot. "Many African HIV-positive women do not breastfeed, and the cost of formula milk does not appear to be a factor breastfeeding illegal."

No effect of migration on contraception
If the desire of children appears very different from the French born in France and those born in Africa, the rate of contraception remains the same.

While 80% of HIV-positive women who do not wish to become pregnant using the pill or IUD, these methods are only used by 20% of HIV + women. They have in effect on the condom to protect a pregnancy.

"It means a hidden support of contraception in these women," laments Isabelle Heard. "However, if the effectiveness of condoms as protection against STIs (sexually transmitted infections) reaches 100% it is only 80% effective against pregnancy."

Women being younger at the beginning of the epidemic and two-thirds of them do not want children, the issue of contraception is important.

50% of them use condoms only, 10% of dual contraception (condom and pill or IUD) while the WHO target is to reach a third, 12% use the pill or IUD without condom 28% have no contraception, contraception or intermittent use barrier contraceptives.

Having casual partners, not to work, to have a low level of education or being in treatment failure is related to a lower use of contraception.

"We must now turn to these women experiencing emotional or social instability," concludes Isabelle Heard.