Abstract #12  -  Mirror, Mirror on the Wall: The Face of HIV+ Women in Europe Today (Findings from the Eurosupport 5 Study)
Authors:   Presenting Author:   Dr Christiana Noestlinger - Institute of Tropical Medicine
Additional Authors:  MD Rebecca Woo, MSc Tom Platteau, PhD Sibylle Nideroest,
Aim: Sexual and reproductive health (SRH) are major components of quality of life. This study aimed at assessing SRH needs of HIV+ people and identified factors influencing sexual risk behaviour in order to improve service provision and decrease sexual risk taking. Since women living with HIV may have pronounced gender-specific needs, we explored in detail a subset of HIV+ women living in Europe with regard to their SRH.
Method / Issue: This European Public Health project (supported by the European Commission) applied a multi-method approach. Formative research with focus groups (FGs) assessed SRH-related needs and problems of HIV+ women. Based on these findings, a cross-sectional quantitative study involving 17 HIV centres in 14 European countries was carried out. This anonymous self-reported questionnaire included demographics, health and SRH related variables, sexual behaviour (prior 6 months), HIV-related knowledge, motivation, behavioural skills; mental health and social support scales were assessed using validated scales (DASS-21; SSI). Systematic contextual data analysis was used to process qualitative data. Descriptive statistics and bivariate analysis (Spearman’s Rho, Mann Whitney U or Chi-Square test depending on variable properties) were computed for quantitative data.
Results / Comments: The qualitative data set combined information from 9 FGs (n=43/39 % were women). The quantitative data set contained valid questionnaires of 387 women (25% of all respondents). Qualitative results show that pleasure and happiness were tied to parenting for many women, but concerns about conceiving safely remained. Life-long adherence to safer sex was viewed as a major challenge, with sexual risk taking perceived as either an expression of intimacy or partner pressure in sexual relationships. Selected quantitative results pertain to 3 areas: motherhood, family planning, positive prevention. 315 (82%) were in their child bearing years and 152 (39%) had children under 18; since HIV diagnosis 135 (35%) had become pregnant, 53 (14%) had terminated a pregnancy, 40 (10%) had experienced a miscarriage . 157 (41%) desired (more) children. 219 (57%) reported contraceptive use (38% used only a condom, 11% used condoms with another method). 249 (64%) had a main sex partner, though 205 (53 %) had sex only with that partner and 49 (13%) had sex with casual partners, while 82 (21%) were sexually inactive in the prior 6 months. Median number of sexual encounters during the last 6 months was 24 with main partners (of which 50% were protected) and 10 with casual partners (of which 4 were protected). Younger age (p= .005), cannabis use (p= .029), desiring a child (p= .001), and an HIV + partner (p< .000) were associated with sexual risk taking.
Discussion: Desire for childbearing and partner issues influenced sexual risk taking of HIV+ women in this clinical convenience sample. SRH and positive prevention services should be integrated to optimize clinical service provision. Constrained by time, language and culturally sensitive issues, providers may improve the effectiveness of treatment by incorporating feedback of women living with HIV.
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