The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women

J Acquir Immune Defic Syndr. 2008 Apr 1;47(4):477-83. doi: 10.1097/QAI.0b013e318165dc52.


Objectives: To estimate the effect of receiving HIV-positive test results on intentions to have future children and on contraceptive use and to assess the association between pregnancy intentions and pregnancy incidence among HIV-positive women in Malawi.

Methods: Women of unknown HIV status completed a questionnaire about pregnancy intentions and contraceptive use and then received HIV voluntary counseling and testing (VCT). Women who were HIV-positive and not pregnant were enrolled and followed for 1 year while receiving HIV care and access to family planning (FP) services.

Results: Before receiving their HIV test results, 33% of women reported a desire to have future children; this declined to 15% 1 week later (P < 0.0001) and remained constant throughout follow-up. Contraceptive use increased from 38% before HIV testing to 52% 1 week later (P < 0.0001) and then decreased to 46% by 12 months. The pregnancy incidence among women not reporting a desire to have future children after VCT was less than half of the incidence among women reporting this desire.

Conclusions: With knowledge of their HIV-positive status, women were less likely to desire future pregnancies. Pregnancy incidence was lower among women not desiring future children. Integration of VCT, FP, and HIV care could prevent mother-to-child HIV transmission.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Contraceptive Agents / administration & dosage*
  • Counseling / methods
  • Counseling / statistics & numerical data
  • Family Planning Services / methods*
  • Family Planning Services / statistics & numerical data
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV Infections / psychology
  • HIV Seropositivity / diagnosis
  • Humans
  • Malawi
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control
  • Pregnancy Complications, Infectious / psychology
  • Pregnancy Complications, Infectious / virology
  • Pregnancy, Unwanted / psychology
  • Prospective Studies
  • Surveys and Questionnaires
  • Time Factors


  • Anti-HIV Agents
  • Contraceptive Agents