HIV and Teenage Pregnancies

posted: 26/01/2011

Behind the good news that 58 London teenagers with HIV successfully gave birth to 66 babies, there’s another story.

This is a saga of sex education that isn’t working, major gaps in HIV prevention, little or no use of contraception, unplanned pregnancies, vulnerable teenagers and sexual abuse, domestic violence, undiagnosed HIV, late diagnosis, further pregnancies after the birth, and complex psycho-social problems. 
 

 

We learn this from the first British study to look at pregnant teenagers with HIV, in the latest issue of the British HIV Association journal, HIV Medicine.

Over the seven years up to 2007, 12 London hospitals found 58 teenage (13 – 19) women with HIV who became pregnant. 66 babies were born live to the 58 mothers and only one baby developed HIV. The mothers (and the babies) have done well and that is what the study was looking into.
 

Gaps and needs

But the study uncovered evidence of significant gaps, and exposed teenagers’ needs and some of the life problems that can help explain these pregnancies, and how HIV pregnancies and HIV transmissions to vulnerable teenagers might be avoided.
 

The young women here faced “difficult medical and social circumstances,” used condoms infrequently, and a quarter became pregnant again within one year. Other studies have shown many young people with HIV have complex psychosocial problems, take high levels of sexual risk and have significant recreational drug and alcohol use. This study found this too.
 

11% of the new HIV diagnoses in the UK are young people aged 16 to 24.

Ethnicity
Four out of five pregnant teenagers have ethnic minority backgrounds:

• Black African, 59%
• Black Caribbean, 17%
• Other ethnicities 10%
• Only 14% were white females.

Almost three quarters (72%) were born abroad.
 

When infected?

One woman was definitely HIV-positive from birth, but as many as 43% of the women might have got HIV as babies from their mothers. These young women were diagnosed with HIV in their teens, but after they begun their sexual lives, so we don't know how they became HIV positive. 
 

Late diagnosis too

Some of the young women were diagnosed at a late stage of HIV : 5% of the young women had already developed symptoms of HIV illness, and 9% had an AIDS-defining condition.

However, most of the women (87%) had no HIV symptoms.
 

Almost two-thirds of the young women (63%) were diagnosed with HIV during the normal antenatal checks, and the others were diagnosed before they became pregnant.
 

How infected?
How might these young women have got HIV?

• 1 (but possibly 25) infected from mother to baby 
• 42 (63%) migrated from a high-HIV-prevalence country (so possibly mother to baby, possibly sexual, possibly through infected blood or tissue)
• 24 (36%) sexually through a ‘high-risk’ partner, or someone with HIV

Most (92%) were sufficiently sexually active before they became pregnant to have had a sexual health screen the year before, and 45% have had another sexually transmitted infection.

No condoms or contraception
Most of the pregnancies (82%) were unplanned, and only four were taking anti-HIV treatments when they conceived.

• Only 1 in 3 used condoms, and often condom use was inconsistent 
• 2 out of 3 didn’t use any contraception.

2nd pregnancies

Despite this, the hospital notes show that less than half (43%) of the new mums were advised about contraception after they had their baby, and not surprisingly 1 in 4 of the women then had a second pregnancy within a year. Contraception advice (and having a baby as a positive teenager) is not enough to prevent conception again. 47% of the second pregnancies followed contraception advice, 88% of the second pregnancies were unplanned and 12% ended with a termination.
 

Life problems
“Significant and complex psychosocial problems” were very common, for example 

• Almost half (45%) were sexually abused
• 58% had housing problems
• 63% had financial problems : only 8% were in paid work, the rest were unemployed (54%) or students (38%).

 

94% took anti-HIV treatment during pregnancy and for most (81%) this was to prevent mother-to-child transmission of HIV. By the time of the birth 62% of women had an undetectable viral load.
 

Good results for mums and babies

The investigators emphasise that despite their vulnerability and difficult social and medical circumstances, these HIV-positive teenagers had a “favourable” result – they did well themselves and their babies are fine.
 

The authors say the good results were due to the “multidisciplinary care the patients received.” This was provided by expert teams working closely together at major London hospitals - HIV physicians, obstetricians, paediatricians and specialist midwifes.
 

They say their study identifies “a need for more effective strategies in the management of HIV-infected teenagers with particular emphasis on sexual and reproductive health.” To meet these needs, the authors call for the establishment of “a one-stop shop including HIV care, sexual and reproductive health input and psychosocial support in an appropriate environment provided by skilled staff in a sensitive and nonjudgmental manner.”
 

UK Guidance Managing the sexual and reproductive health of teenagers with HIV

 

Acute HIV prevention needs of vulnerable teenagers

While this study says nothing about HIV prevention needs, (they were studying how well the the care for HIV positive pregnant teenagers and babies worked), it is very plain that these pregnancies, and teenagers becoming HIV positive exposes a major failure to meet HIV prevention needs.

At least a third of these teenage women were sexually infected with HIV. 

Almost all of these teenagers were sexually active in the year before they became pregnant, when they may not yet have got HIV. 92% of them had a sexual health screen in the year before they became pregnant. Almost half have had an STI.

Four out of five have an ethnic minority background; three quarters were born abroad and are migrants.

Most have complex psycho-social needs and are likely to be in contact with other services.

Target vulnerable teens for intensive HIV prevention

All services providing sexual health checks and contraception services to teenage women matching this profile should particularly target HIV information and support services to meet those needs.

The teenagers' male partners are invisible in this study - some must have HIV. There is a risk that those males without HIV might get HIV from their girlfriends, because few of the males are using condoms consistently.

We know nothing about their male partners' ages, ethnicities, whether they are migrants, use of sexual health services, or whether they are also vulnerable because of complex psycho-social problems. We need more information before we can meet the male partners' HIV and contraception support needs.       

 

Source, with reference

Related news - Unplanned pregnancies in teenagers infected from their mothers

Permalink

---