When considering pregnancy, many HIV-positive women grapple with the potential impact of their HIV status on their children and the stigma associated with childbearing among infected women, according to "‘Throwing the Dice’: Pregnancy Decision-Making Among HIV-Positive Women in Four U.S. Cities" by Sheri B. Kirshenbaum of the HIV Center for Clinical and Behavioral Studies at Columbia University and the New York State Psychiatric Institute, et al. Women in the United States are generally expected to have or want children, yet those who are HIV-positive must balance desires for children with personal and societal beliefs about responsible motherhood.

This qualitative analysis of in-depth interviews with 56 HIV-positive women in four U.S. cities finds that many women are deterred from having children primarily by the thought that they could infect their child during pregnancy. Women tended to overestimate the risk of vertical (mother-to-child) transmission, which occurs in fewer than 2% of cases for women who begin treatment early in pregnancy. Women’s decisions were also influenced by the thought that they could become unable to care for a child because of illness, disability or death.

At a time when the number of HIV-positive women in the U.S. is increasing and the majority of those women are of reproductive age, it is important to understand the factors influencing family planning decision-making, and to counter misconceptions and misinformation about mother-to-child risk and treatment options through family planning education and counseling, in order to allow HIV-positive women to make difficult decisions based on the best possible information.

"‘Throwing the Dice’: Pregnancy Decision-Making Among HIV-Positive Women in Four U.S. Cities" is published in the May/June 2004 issue of Perspectives on Sexual and Reproductive Health.