Exploring Childbearing Intentions and Reproductive Behavior among Minority Adolescent and Young Adult Females with Behaviorally-Acquired HIV Infection

Published data on the childbearing intentions and reproductive behavior of those living with behaviorally-acquired HIV is lacking. This study is the first to qualitatively explore the childbearing intentions and reproductive behavior of adolescent and young adult females living with behaviorally-acquired HIV infection and to evaluate factors that may influence their reproductive decision-making. Results from this study will aid in the design of reproductive health interventions and policy strategies to improve the reproductive health of this population. Data for the present study was derived from in-depth semi-structured interviews conducted as part of a larger parent study (The Positive Challenge Study), which explored the way in which African American and Latino youths in the New York City metropolitan area adjusted to living with behaviorally-acquired HIV infection. Data analyzed in the present study comprised twenty-six initial interviews and thirteen follow-up interviews with twenty-six female youths aged 16 to 24 years. The study utilized a conceptual framework based on the Theory of Planned Behavior (TPB). The TPB posits that attitudes towards behavior, subjective norms, and perceived behavioral control, can predict intention and behavior. Deductive and inductive approaches to data analysis were employed. Deductive thematic content analysis employed theory-based a priori codes to explore the interview data. A simultaneous inductive coding approach captured categories and themes emerging from the interviews. A three-level coding process reduced the interview data to identify categories, patterns, and themes. The following major themes emerged: Theme 1: HIV complicates reproductive decision-making, but the vast majority of adolescent and young adult females with behaviorally-acquired HIV infection have a positive attitude toward childbearing; and many young women with HIV plan to have children, or have already had children. Childbearing beliefs and intentions appear to change over time. Theme 2: Having children helps young mothers with HIV cope psychologically with their diagnosis, and is a positive and enriching life experience, but there are challenges such as balancing parenting responsibilities and HIV care; fears about disclosing their HIV status to their children; and fears about dying and leaving their children without a mother. Theme 3: While accomplishing childbearing goals, young women with HIV strategize ways to control perinatal and secondary HIV transmission. Both female-controlled methods and male-controlled methods are used to manage fertility and prevent HIV transmission. Theme 4: Significant others play an important role in childbearing intentions and reproductive behavior, with romantic partners bearing the most influence. Family pressure and normative beliefs about childbearing also influences childbearing intentions and reproductive behavior. (Abstract shortened by UMI.