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Decrease of condom use in heterosexual couples and its impact on pregnancy rates: the Swiss HIV Cohort Study (SHCS)
Anna Hachfeld1, Andrew Atkinson1,2, Alexandra Calmy3
1Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
HIV Medicine
|September 3, 2021
Summary
The 2008 Swiss statement encouraged condomless sex for HIV-serodiscordant couples, increasing its practice without raising pregnancy rates. However, spontaneous abortion rates rose, indicating unmet family planning needs for women with HIV.
Area of Science:
- Reproductive Health
- Infectious Diseases
- Public Health Policy
Background:
- The 2008 "Swiss statement" permitted condomless sex for HIV-serodiscordant couples aiming for natural conception.
- This policy shift aimed to reduce condom use and increase pregnancy events in this population.
Purpose of the Study:
- To analyze the impact of the "Swiss statement" on condom use and pregnancy outcomes in HIV-serodiscordant couples.
- To investigate changes in pregnancy incidence, live birth rates, and abortion rates following the statement's release.
Main Methods:
- Analysis of 3023 women from the Swiss HIV Cohort Study (aged 18-49).
- Data divided into pre- (2005-2008) and post-statement (2009-2019) periods.
- Utilized descriptive statistics, Poisson interrupted time series, and logistic regression.
Main Results:
- Condomless sex increased significantly from 25% to 75% post-statement.
- Pregnancy incidence remained stable, but spontaneous abortion rates increased (12.1% vs. 17.2%).
- Older age, alcohol consumption, and non-suppressed viral load predicted spontaneous abortions; depression and non-suppressed viral load predicted induced abortions.
Conclusions:
- The "Swiss statement" led to increased condomless sex but not higher pregnancy incidence.
- Rising spontaneous abortion rates and stable induced abortion rates suggest unmet family planning needs.
- Targeted counseling and support are crucial for women living with HIV regarding reproductive health.
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