Browsing by Author "Adewole, I. F."

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Acceptability of child adoption as management option for infertility in Nigeria: evidence from focus group discussions
(2009) Oladokun, A.; Arulogun, O.; Oladokun, R.; Morhason-Bello, I. O; Bamgboye, E. A.; Adewole, I. F.; Ojengbede, O. A.
Infertility remains a global health challenge with devastating psycho-social consequences in many African communities. Adoption that may serve as an alternative strategy for the affected couples is not widely practiced. This study was conceptualized to assess the acceptability of child adoption as a management option by Nigerians. Twelve focus group discussions were held involving three communities stratified into inner core, transitory and peripheral, within Ibadan metropolis, South-Western Nigeria from May to July 2008. The participants were purposively selected based on gender and age group. The barriers mentioned were cultural practices, stigmatization, financial implications, and procedural bottle-necks. Measures suggested to curb these negative attitudes were advocacy, community mobilization and enactment of supportive law that will protect all parties involved
Acceptability of counseling and testing for HIV infection in women in labour at the University College Hospital, Ibadan, Nigeria
(Makerere University, 2011-03) Bello, F.; Ogunbode, O. O.; Adesina, O. A.; Olayemi, O.; Awonuga, O. M.; Adewole, I. F.
Background: Many patients are referred to labour ward as emergencies, and therefore do not benefit from the antenatal HIV counselling and testing and treatment offered to registered patients. Objective: To assess the acceptability and suitability of offering HIV counselling and testing to women of unknown HIV status presenting in labour. Methods: A cross-sectional study comprising counselling and obtaining consent for HIV testing among 104 unregistered patients who presented in labour over a 3-month period. Rapid and enzyme-linked immunosorbent assay screening was performed for 90 consenting respondents. Reactive results were confirmed by Western blot. Appropriate therapy was instituted. Results: Acceptance rate for HIV testing was 86.5%, prevalence of HIV was 6.7%. Women of lower educational status were more likely to accept testing in labour (OR: 0.3; 95% CI: 0.1-0.7; p=0.01); age, parity, occupation and knowledge of HIV had no influence. Most women (66.3%) had satisfactory knowledge of HIV. No one admitted to feeling coerced to test in fear of being denied care. Most refusals for screening were to avoid needle pricks (28.6%). Compared to ELISA screening test, specificity of the rapid test was 100%, sensitivity 85.7%, positive predictive value 100% and negative predictive value 98.8%. Attitude to testing was maintained on post-partum re-evaluation. Conclusion: The prevalence of HIV amongst unregistered parturients showed the importance of offering point-of-care HIV testing and intervention, especially in an environment where antenatal clinic attendance is poor. Rapid testing appeared to be acceptable and feasible in labour to prevent the mother-to-child transmission of HIV.
Africa and cancer: preparing for the next epidemic
(2012) Adewole, I. F.
Asymptomatic bacteriuria among HIV positive pregnant women
(Taylor and Francis, 2010-06) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; Mutiu, W. B.; Adewole, I. F.
The prognostic significance of asymptomatic bacteriuria resides in the observation that the prevalence is, relatively, high in persons with certain medical conditions, such as diabetes mellitus and pregnancy. This prevalence might, even, be higher in patients with human immunodeficiency virus infection. Hence, this study set out to determine the prevalence of asymptomatic bacteriuria among symptom free and newly enrolled HIV infected pregnant women attending PMTCT unit of Antiretroviral Clinic of University College Hospital, Ibadan, Nigeria between 1st May and 30th September 2007. Information was obtained on the socio-demographic characteristics of the subjects, CD4 count and viral load. Microbial culture was carried out on aseptically collected urines from the patients. Statistical analysis was done with SPSS 12 package. There were 161 analyzable samples from the participants. The mean age and gestational age at presentation of participants was 30.49 ± 4.3 years and 27.3 ± 3.2 weeks, respectively with modal parity of 2. Twenty-five (15.5%) of the urine samples significantly grew bacteria. The CD4 cells were significantly lower and the viral loads significantly higher (250.52 vs. 355.57 cells/mm3; 88,731 vs. 55,384 copies/ml; p = <0.0000) for the urine culture positive patients. Eshcherichia coli were isolated in 48%, Proteus in 16.0%, Klebsiella in 8.0% and Staphylococcus aureus in 28.0% of the urine positive cultures. The study showed that the prevalence of asymptomatic bacteriuria among PLWHAs is high. The microbial isolate from the urine samples were not different from those of HIV-negative patients.
Asymptomatic bacteriuria among HIV positive pregnant women
(2010) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; Mutiu, W. B.; Adewole, I. F.
The prognostic significance of asymptomatic bacteriuria resides in the observation that the prevalence is, relatively, high in persons with certain medical conditions, such as diabetes mellitus and pregnancy. This prevalence might, even, be higher in patients with human immunodeficiency virus infection. Hence, this study set out to determine the prevalence of asymptomatic bacteriuria among symptom free and newly enrolled HIV infected pregnant women attending PMTCT unit of Antiretroviral Clinic of University College Hospital, Ibadan, Nigeria between 1st May and 30th September 2007. Information was obtained on the socio-demographic characteristics of the subjects, CD4 count and viral load. Microbial culture was carried out on aseptically collected urines from the patients. Statistical analysis was done with SPSS 12 package. There were 161 analyzable samples from the participants. The mean age and gestational age at presentation of participants was 30.49 ± 4.3 years and 27.3 ± 3.2 weeks, respectively with modal parity of 2. Twenty-five (15.5%) of the urine samples significantly grew bacteria. The CD4 cells were significantly lower and the viral loads significantly higher (250.52 vs. 355.57 cells/mm3; 88,731 vs. 55,384 copies/ml; p = <0.0000) for the urine culture positive patients. Eshcherichia coli were isolated in 48%, Proteus in 16.0%, Klebsiella in 8.0% and Staphylococcus aureus in 28.0% of the urine positive cultures. The study showed that the prevalence of asymptomatic bacteriuria among PLWHAs is high. The microbial isolate from the urine samples were not different from those of HIV-negative patients.
An audit of the uptake of key PMTCT interventions in the pre and post WHO rapid advice periods at the University College Hospital, Ibadan
(2015-05) Adesina, O. A.; Kuti, M. A.; Ogunbosi, B.; Akinyemi, O. J.; Fayemiwo, A.; Awolude, O. A.; Adewole, I. F.
Prevention of vertical transmission of HIV may require the uptake of the culturally unacceptable options of cesarean delivery and formula feeding. The successful use of HAART, as enumerated by the WHO 2009 rapid advice, has the potential for facilitating the uptake of the more culturally acceptable vaginal delivery and breast feeding. These recommendations became operational at the PMTCT unit, University College Hospital, Ibadan. This retrospective study describes the impact of these recommendations on the uptake of PMTCT interventions at our center. The pre-rapid advice period was June 2009 to April 2011 and the post rapid period May 2011 till December 2012. Pre-rapid advise, antiretrovirals administered was zidovudine or Combivir for women with CD4 The new WHO guidelines appear to have facilitated a shift in uptake of the more culturally acceptable options of vaginal delivery and breast feeding. A follow-up evaluation of the infant HIV status will ascertain the ultimate impact on MTCT. >200cells / ml and Combivir/nevirapine for CD4 <200 Cells/ ml. Post-rapid, all were eligible for HAART (mostly efavirenz/ truvada or efavirenz/ Combivir). Six weeks post-natally, the options adopted were documented and are presented here. Information from 1165 women was available. Thirty three (2.8%) did not have adequate information and were excluded. There were 711 women pre-rapid advise and 421 women post rapid. The women's characteristics were not significantly different over both periods, 69.0% had >6 years of education, 97.0% were married and slightly over half (56.9%) were involved with traders. Overall, more women were delivered by the vaginal route than Caesarean Delivery (70.5% vs. 29.5%), while more breastfed compared to formula feeding (67.2% vs. 32.8%). In the post rapid period (compared to the pre- rapid) advise, more women had vaginal delivery (73.5% vs. 64.8%, p = 0.54), more women breast-fed (77.0% vs. 50.1%, p= 0.00) and fewer women used contraception (21.5% vs. 27.3%, p= 0.023). The commonest method was the condom (83.4%). The new WHO guidelines appear to have facilitated a shift in uptake of the more culturally acceptable options of vaginal delivery and breast feeding. A follow-up evaluation of the infant HIV status will ascertain the ultimate impact on MTCT
An audit of the uptake of key PMTCT interventions in the pre and post WHO rapid advice periods at the University College Hospital, Ibadan
(Society of Gynaecology and Obstetrics of Nigeria, 2015-04) Adesina, O. A.; Kuti, M. A.; Ogunbosi, B.; Akinyemi, O. J.; Fayemiwo, A.; Awolude, O. A.; Adewole, I. F.
Prevention of vertical transmission of HIV may require the uptake of the culturally unacceptable options of cesarean delivery and formula feeding. The successful use of HAART, as enumerated by the WHO 2009 rapid advice, has the potential for facilitating the uptake of the more culturally acceptable vaginal delivery and breast feeding. These recommendations became operational at the PMTCT unit, University College Hospital, Ibadan. This retrospective study describes the impact of these recommendations on the uptake of PMTCT interventions at our center. The pre-rapid advice period was June 2009 to April 2011 and the post rapid period May 2011 till December 2012. Pre-rapid advise, antiretrovirals administered was zidovudine or Combivir for women with CD4>200cells / ml and Combivir/nevirapine for CD4 <200 Cells/ ml. Post-rapid, all were eligible for HAART (mostly efavirenz/ truvada or efavirenz/ Combivir). Six weeks post-natally, the options adopted were documented and are presented here. Information from 1165 women was available. Thirty three (2.8%) did not have adequate information and were excluded. There were 711 women pre-rapid advise and 421 women post rapid. The women's characteristics were not significantly different over both periods, 69.0% had >6 years of education, 97.0% were married and slightly over half (56.9%) were involved with traders. Overall, more women were delivered by the vaginal route than Caesarean Delivery (70.5% vs. 29.5%), while more breastfed compared to formula feeding (67.2% vs. 32.8%). In the post rapid period (compared to the pre- rapid) advise, more women had vaginal delivery (73.5% vs. 64.8%, p = 0.54), more women breast-fed (77.0% vs. 50.1%, p= 0.00) and fewer women used contraception (21.5% vs. 27.3%, p= 0.023). The commonest method was the condom (83.4%). The new WHO guidelines appear to have facilitated a shift in uptake of the more culturally acceptable options of vaginal delivery and breast feeding. A follow-up evaluation of the infant HIV status will ascertain the ultimate impact on MTCT.
Awareness and desirability of the Nigerian antenatal women about analgesia use during childbirth
(2007-12) Oladokun, A.; Morhason-Bello, I.O.; Eyelade, O. R.; Adedokun, B. O.; Akinycmi, J O.; Adewole, I. F.
Bacterial antibiotic sensitivity pattern from urine of asymptomatic HIV positive pregnant women
(2011) Awolude, O. A.; Adesina, O. A.; Mutiu, W. B.; Adewole, I. F.
Introduction: Asymptomatic bacteriuria (ASB) in pregnancy with adverse pregnancy outcome has been well documented with Escherichia coli and other gram-negative rods being the common organism associated. However, most of these studies were done in patients without additional immunosuppressant except for pregnancy. However; the additional risk of HIV infection in pregnant woman necessitates the evaluation of the microbial isolates and antibiotic sensitivity pattern from the urine samples of these patients without any symptom. Methods: A prospective cohort study was undertaken among HIV positive pregnant women attending our Antiretroviral clinic between 1st May and 30th September 2007. Information recorded from the patient questionnaire included age, parity, marital status, occupation, and level of education. Culture and antibiotic sensitivity was carried out on aseptically collected urines from the patients. Results: Twenty-five. (15.5%) of the 161 urine samples cultured significantly grew organisms. Four of the urine specimen had, in addition, Candida isolated. The mean age of participants was 30.6 ± 4.3 years .and the modal parity was 2. The mean gestational age at presentation was 27.3± 3.2 weeks. Escherichia coli was isolated in 48%, Proteus in 16:0%, Klebsiella in 8.0%, and Staphylococcus aureus in 28.0%. The antibiotic sensitivity test showed that the organisms were 100% sensitive to ciprofloxacin, 80% sensitive to cefuroxime, 60% sensitive to ofloxacin and augmentin but only 36%, 20%, 8.0% and 4.6% sensitive to co-trimoxazole, amoxycillin, chloramphenicol, erythromycin, nitrofurantoin and gentamycin, respectively. The organisms were 100% resistant to tetracycline and ampicillin. Conclusion: This-study shows that the microbial isolates of the ASB among HIV positive pregnant women are similar to those of HIV-negative counterparts but with varying drug sensitivities.
Blood transfusion requirement during caesarean delivery: risk factors
(Association of Resident Doctors, University College Hospital, Ibadan, Nigeria, 2015-06) Eyelade, O. R.; Adesina, O. A.; Adewole, I. F.; Adebowale, S. A.
Background: Group specific blood is often cross-matched ready for all patients scheduled for caesarean section in anticipation of haemorrhage during the surgery. This study was conducted to determine the risk factors for blood transfusion during anaesthesia for caesarean section. Methods: This was a prospective cross-sectional study. A total of 706 pregnant patients scheduled for emergency or elective Caesarean section at the University College Hospital, Ibadan, Nigeria between March and August 2011 were recruited. Participants were followed-up from the date of delivery till the end point of the study which could fall into either of the following conditions: satisfactory postoperative clinical status up to 48 hours post-delivery or death. Transfusion rate was determined and Chi-square test was used to determine if there exist an association between blood transfusion status and preoperative haematocrit level, years of experience of obstetrician, indication for Caesarean Section(CS), CS type (primary or repeat) and HIV status. Results: Transfusion rate was 9.1 %; variables found to be significantly associated with blood transfusion were; preoperative haematocrit less than 26%, increasing parity, years of experience of resident obstetrician, indication for CS (bleeding or not bleeding) and estimated blood loss. Being HIV positive does not increase the need for blood transfusion. Conclusion: Preoperative anaemia, increasing parity and severe blood loss at surgery significantly contribute to the requirement for blood transfusion in patients undergoing caesarean section.
Cervical cytology service in Nigeria: providers’ perspective
(Taylor and Francis, 2003-07) Adesina, O. A.; Babarinsa, I. A.; Fawole, A. O.; Oladokun, A.; Adeniji, R. A.; Adewole, I. F.
It has been noted that efforts to organise an effective screening programme in developing countries will have to find adequate financial resources, develop the infrastructure, train the necessary manpower and elaborate surveillance mechanisms. In our study, we set out to determine (a) just how frequent is cervical cancer, to warrant the investment of funds in screening programmes; (b) what proportion of surveyed health facilities offer a cervical cytology screening programme; and (c) what basic facilities are currently available where such programmes exist? A pretested, self-completed questionnaire was sent to heads of department of obstetrics and gynaecology in public tertiary and secondary care hospitals in Nigeria as well as major mission hospitals. The response rate was 63%, monthly consultations included a mean of 114 (±11.7) new gynaecological patients and an average of 5 (4.7±0.8) cervical cancer cases. One-half of the institutions had a hospital-based cervical screening programme with an average of 27 patients being screened monthly. Finance was the main difficulty encountered in maintaining a screening service. Only four had a certified gynaecological oncologist. In conclusion, there is dismal utilization of available services and a dearth of trained specialists should any cervical cancer screening programme be considered.
Community gate keepers' awareness and perception of prevention of mother-to-child transmission of HIV services in Ibadan, Nigeria
(2007) Arulogun, O. S.; Adewole, I. F.; Olayinka-Alli, L.; Adesina, A. O.
Each year, around half a million children aged under 15 become infected with HIV and more than 90% are the result of mother-to-child transrnission. Services to prevent mother-to-child HIV transmission (PMTCT) are therefore important entry points for HIV AIDS Prevention, treatment and care services for women, their children and families. The study aimed at identifying level of awareness and knowledge of PMTCT services that can be utilized in improving access. The methodology consisted of 20 individual in-depth interviews spread over Adabeji, Adeoyo/Agbadagbudu, Jakiru/Onipasan and Eleta communities, in Ibadan among household heads, religious and community based leaders. Key factors identified were low knowledge of mother to child transmission, lack of knowledge of the PMTCT services, inadequate community sensitization, inadequate health care facilities. The success of PMTCT programmes demands a shift towards a more community-based approach which calls for strong advocacy, enlightenment and community mobilization for improved awareness and utilization of PMTCT services
A comparative study of two surgical management methods for cervical incompetence at the University College Hospital, Ibadan
(Nigerian Medical Association, Akwa Ibom State Branch, 2007-02) Oladokun, A.; Adesina, O. A.; Odukogbe, A. A.; Morhason-Bello, I. O.; Adewole, I. F.
Incompetence of the internal uterine cervical os is associated with recurrent pregnancy loss. Different surgical techniques are in practice to correct the defect. The objective of this study therefore was to review the outcome of pregnancies following cervical using either of the two procedure among patients diagnosed as having incompetence of the cervix. A comparative study of 2 standard methods of cerclage used in our hospital, McDonald & Shirodkar, in a group of 80 patients was done. All the patients had cervical cerclage insertion done between the 14 & 16 weeks of gestation using either of the two methods. There was no significant morbidity with either of the 2 methods. The overall success rates, as measured by continuation of the pregnancy to term, were similar. Both methods of cervical cerclage are equally effective in producing the desired outcome, but since the McDonald method is technically simpler to perform, it may be desirable to adopt this approach more frequently.
Condom use among antiretroviral therapy patients in Ibadan, Nigeria
(2010) Akinyemi, J. O.; Awolude, O. A.; Awolude, O. A.; Adewole, I. F.; Kanki, P. J.
Background: While antiretroviral treatment (ART) has improved the health status of people living with HIV, new challenges to their sexual and reproductive health (SRH) needs and their ability to prevent secondary HIV infections have risen. This study aimed to determine the level and factors that affect condom use among ART-experienced patients at the premier teaching hospital in Nigeria. Methodology: This longitudinal study involved patients who initiated treatment at the University College Hospital, Ibadan, Nigeria, between January and December 2006. Sexually active patients who had received treatment for at least six months and had not defaulted on clinic follow-up schedules were studied. Data on socio-demographic characteristics and condom use were extracted from clinic records. Chi square test and logistic regression were employed to determine factors associated with condom use. Results: The study involved 866 patients, specifically, 306 (35.3%) men and 560 (64.7%) women aged 40.7 (SD 7.6) and 33.3 (SD 6.5) years respectively. Condoms usage before treatment and at last clinic visits was 14.0% and 43.3% respectively. Overall reports of condom use at specified periods were as follows: 1 – 6 months (33.0%); 7 – 12 months (37.3%) and above 12 months (53.8%). Patients in a marital union and those with higher education were more likely to use condoms. Conclusions: Condom use is significantly influenced by marital status and educational level. Although condom use increases together with follow-up time, the level can be improved. Primary and secondary prevention efforts targeting high-risk sexual behaviour among ART patients need to receive greater and continual attention.
Consensus recommendations for the prevention of cervical cancer in Sub-Saharan Africa
(2013) Adewole, I. F.; Abauleth, Y. R.; Adoubi, I.; Amorissani, F.; Anorlu, R. I.; Awolude, O. A.; Botha, H.; Byamugisha, J. K.; Cisse, L.; Diop, M.; Doh, S.; Fabamwo, A. O.; Gahouma, D.; Galadanci, H. S.; Githanga, D.; Magure, T. M.; Mabogunje, C.; Mbuthia, J.; Muchiri, L. W.; Ndiaye, O.; Nyakabau, A. M.; Ojwang, S. B. O.; Ramogola-Masire, D.; Sekyere, O.; Smith, T. H.; Taulo, F. O. G.; Wewege, A.; Wiredu, E.; Yarosh, O.
Cervical cancer is the second most common cancer and the leading cause of cancer-related death in women in sub-Saharan Africa. It is estimated that more than 200 million females older than 15 years are at risk in this region. This paper highlights the current burden of cervical cancer in sub-Saharan Africa, reviews the latest clinical data on primary prevention, outlines challenges in the region, and offers potential solutions to these barriers. Based on these factors, clinical recommendations for the prevention of cervical cancer from the sub-Saharan African Cervical Cancer Working Group expert panel are presented.
Correlates of HIV sero-disclosure and partner status at a PMTCT centre, UCH
(Corporate Office, One Media Studies, Ibadan, 2011) Adesina, O. A.; Awolude, O.; Akinyemi, A.; Oladokun, A.; Adewole, I. F.; Kanki, P.
Correlates of HIV sero-disclosure and partner status at a PMTCT centre, UCH, Ibadan
(2010) Adesina, O. A.; Awolude, O. A.; Akinyemi A.; Oladokun, A.; Adewole, I. F.; Kanki, P.
Correlation of cervical cytology and visual inspection with acetic HIV-positive women
(Informa Healthcare USA, Inc, 2008) Akinwuntan, A. I.; Adesina, O. A.; Okolo, C. A.; Oluwasola, O. A.; Oludokun, A.,; Ifemeje, A. A.; Adewole, I. F.
The prevalence of squamous intraepithelial lesion is higher among human immunodeficiency virus (HIV)-positive women. These lesions when they occur in these patients are also more difficult to treat. A total of 205 consenting HIV-seropositive women were recruited. A cervical cytology (Pap smear) was taken, followed by visual inspection with freshly prepared 5% acetic acid and cervical biopsy taken from the squamocolumnar junction as the reference for diagnosis to avoid verification bias. The sensitivity of VIA was 76.0% (95% CI 52.0-91.0); specificity 83.0% (95% CI 77.0-88.0); positive predictive value 34.0% (95% CI 21.0-49.0). The sensitivity of cervical cytology (Pap smear) was 57.0% (95% CI 34.0-77.0), specificity of 95.0% (95% CI 90.0-97.0), and positive predictive value of 55.0% (95% CI 33.0-75.0). In HIV-seropositive women, the sensitivity of VIA is 76.0%, making it a useful screening test for preinvasive lesion of the cervix in low resource settings.
Demographic and epidemiological characteristics of HIV opportunistic Infections among older adults in Nigeria
(2017) Akinyemi, J. O.; Ogunbosi, B. O.; Fayemiwo, A. S.; Adesina, O. A.; Michael, O.; Kuti, M. A.; Awolude, O. A.; Olaleye, D. O.; Adewole, I. F.
Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.
Differences in unintended pregnancy, contraceptive use and abortion by HIV status among women in Nigeria and Zambia
(2014) Bankole, A.; Keogh, S.; Akinyemi, J. O.; Dzekedzeke, K.; Awolude, O. A.; Adewole, I. F.
CONTEXT: Sub-Saharan Africa is burdened by high rates of unintended pregnancy and HIV. Yet little is known about the relationship between these two health risks in the region. Understanding the associations between HIV status and pregnancy decision making may benefit strategies to reduce unintended pregnancy. METHODS: In 2009–2010, household-based surveys of 1,256 women in Nigeria and 1,280 women in Zambia collected information on social and demographic characteristics, unintended pregnancy, contraceptive use, abortion and self-reported HIV status. Multivariate models were used to examine the association of reported HIV status with nintended pregnancy and abortion in the five years preceding the survey and with contraceptive use at the time of conception. RESULTS: HIV-positive and HIV-negative women did not differ in their odds of unintended pregnancy or of having an abortion. However, HIV-positive women were more likely than HIV-negative women to have been using a contraceptive at the time their unintended pregnancy was conceived (odds ratio, 3.2). Women who did not know their HIV status were less likely than HIV-negative women to report an unintended pregnancy (0.6). However, they were also less likely than HIV-negative women to have been using a contraceptive at the time of conception (0.5). CONCLUSION: HIV-positive women may be making greater efforts than HIV-negative women to prevent unintended pregnancy, but with less success. Efforts should be made to improve access to effective contraceptive methods and counseling for all women, and for HIV-positive women in particular.