474. Reproductive Health of HIV Infected Refugee Women in Boston, Massachusetts
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Background: Observational studies suggest high numbers of HIV+ refugee women in the U.S. become pregnant after resettlement.  We sought to describe pregnancy factors in a population of HIV+ refugee women as compared to a matched cohort of HIV+ US-born women.

Methods: Retrospective chart review was conducted on 59 HIV+ women at least 18 years old with refugee, asylee, or asylum-seeking status and at least two physician visits during 2002-2008.  40 were matched by age and intake year to US-born HIV+ women.  A descriptive analysis of health, psychosocial factors, pregnancy incidence and outcomes using Cochran-Mantel-Haenszel test and unmatched analysis was performed.

Results: 92% of the refugees were from Sub-Saharan Africa with 55% being survivors of torture.  The US-born women were 65% African-American.

At intake, mean age of all women was 32 years.  US-born women had a known HIV diagnosis a mean of 10.9 years compared with 1.4 years in refugee women.  Refugee women were less likely to have disclosed HIV status to others.  Median CD4 count, marital status, and education were similar between the two groups.

49% of the 59 HIV+ refugees were pregnant at least once during the study period.  Mean time from resettlement to first pregnancy was 20 months. Refugee women with pregnancy were more likely to be younger and live with a partner than refugee women without pregnancy. They were also less likely to report a history of sexual trauma or be engaged in mental health care.

In the matched analysis, 53% of the HIV+ refugees were pregnant at least once totaling 34 pregnancies. Of these 55.9% carried to term and 35.3% electively terminated.  In comparison, 45% of the US-born women were pregnant at least once totaling 36 pregnancies; 55.6% carried to term and 36.1% electively terminated. At intake, 20% of the refugee women vs. 32.5% of the US-born women were pregnant. All women received HAART during pregnancy with no transmission of HIV to infants.

Conclusion: HIV+ refugees had high rates of pregnancy similar to HIV+ US-born women.  But they were less likely to disclose their HIV status or engage in mental health services.  Further studies are needed to elucidate barriers to disclosure, acceptance of mental health support, and to understand fertility patterns in this unique population.

Subject Category: H. HIV/AIDS and other retroviruses

Gloria Aggrey, MD1, Margaret Sullivan, MD2, Sondra Crosby, MD1 and Sandeep Menon, BHMS (MD), MPH, PhD1, (1)Boston Medical Center, Boston, MA, (2)Boston Medical Center, Sudbury, MA


G. Aggrey, None

M. Sullivan, None

S. Crosby, None

S. Menon, Biogen Inc: senior biostatiscian, Salary

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