Teens infected with HIV are at a higher risk for pregnancy and complications due to pregnancy than their uninfected peers, Allison Agwu, from the Hopkins Children’s Center, has found in a recent study.
Using a Red Cross-affiliated HIV resource network of eighteen sites across the United States, Agwu and her team tried to assess specific trends affecting teenagers with AIDs.
“It’s a rich database,” Agwu said. “We queried it for any individuals who were pregnant below age 24 and would go back to the site to get additional data. We then queried with a three-page questionnaire regarding the pregnancy, outcomes, length of gestation at birth, etc.”
Their findings indicated that teens who contracted the virus behaviorally (unprotected sex or drug abuse) rather than at birth had higher rates of multiple pregnancies. When asked about why that would be, Agwu responded by saying, “That’s the million dollar question.”
Agwu notes that there are several extraneous factors that could have affected their study.
“This is a bit of a biased sample in that many of [the participants] have been sexually active before. This is a sample that is rich for a higher propensity to become pregnant,” said Agwu. “Many of them were more sexually active and that’s how they got the disease to begin with.”
Agwu emphasized the normalcy of wanting to procreate.
“Getting HIV doesn’t mean you don’t want what young people want — it doesn’t necessarily change that,” she said. “I think we need to make sure we don’t say it’s abnormal to have sexual activity, and it’s easy for people to look at that diagnosis and say ‘You shouldn’t do that.’”
She also mentioned how after contracting HIV, the dynamics of a relationship have to change. For example, couples who have not used condoms before may have to begin to do so.
In addition, Agwu said that it is important to remember that some of these pregnancies may have been desired. “These young individuals are struggling with how procreation fits into their lives,” she explained.
In particular, it is essential that the diagnosed young women receive the proper care and advice if they do plan to become pregnant. “We have to find the best way to prevent transmission to both the partners and fetuses,” said Agwu.
The pregnancies can be fraught with complications, however. “The main thing we worry about is transmission,” explained Agwu. “We have to make sure to get [the women] on antiretroviral therapy.”
Their studies have indicated a correlation between having the virus and problems during labor and with premature births. However, while such a correlation is intriguing, it might not be attributed only to AIDS; Agwu hypothesizes that the cause of complications is multifactorial.
Agwu firmly believes that above all, these young women need counseling and care.
“If they want to be pregnant, they’re going to do it,” Agwu emphasized. “We have to figure out what someone’s desire is and figure out the best way to protect them, the partner, and unborn child from transmission.” In their study, Agwu and her team found that many of the participants have been seen by the same provider since they were very young, and related that to how parents don’t want to talk about sex with their young children.
“Risk prevention starts early,” she said. “We need to introduce that to the providers, the case workers, outreach workers, risk reduction counselors — this topic needs be introduced continuously and the parents have to be brought in. This is a full team effort.”
In the late ‘80s and early ‘90s, AIDS patients were stereotyped and shunned from society. Even today, although progress has been made in diagnosing and treating the disease, people suffering from AIDS are often still stigmatized, and Agwu wants that to change.
“If we do stigmatize it, then they’re not going to disclose [the fact that they have AIDS], and then we have less opportunity to counsel them,” she said. She mentioned how there are other factors to be worried about, including sexually transmitted infections.
In addition, she wants to make questions about sex a part of normal care in the populations they have studied. Agwu drove home the point that risk needs to be redefined. “There’s a tendency to read the article and have readers thinking about risk as ‘oh, she’s had multiple partners,’ but the prevalence of HIV is so high that we have to recalibrate it. Some of these girls have only had one partner before they were infected.”
