Bundling HIV Prevention with Prenatal Care Reduces Risky Sex Behaviors Among At-risk Mothers
• Science Update
An HIV-prevention program targeted at women receiving prenatal care may effectively reduce risks for HIV, sexually transmitted infections (STIs), and unplanned future pregnancies, according to NIMH-funded researchers. Bundling such interventions into existing health care models, like prenatal care, also may be more accessible to those who may not have the time, interest, or resources to attend a stand-alone HIV prevention program. Changing the way prenatal care is provided also may create sustainable advantages in reproductive health for all at-risk women. The study was published in the November 2009 issue of the American Journal of Public Health.
The very behaviors that put young women at risk for pregnancy also put them at risk for STIs. Since they are no longer trying to prevent pregnancy, young, pregnant women are less likely to use condoms than their non-pregnant peers. This, in turn, puts them at high risk for contracting HIV and other STIs during and shortly after pregnancy. However, few HIV interventions have been developed to address the specific needs of young, pregnant women.
For their study, Jeanette Ickovics, Ph.D., of Yale University, and colleagues recruited 1,047 teens and young women (ages 14-25). All participants were in their second trimester of pregnancy and receiving prenatal care at one of two clinical sites during 2001-2004. The researchers randomly assigned the study participants to one of three care groups:
- Standard CenteringPregnancy group prenatal care
- CenteringPregnancy group prenatal care + HIV prevention components
- Standard individual prenatal care
CenteringPregnancy consisted of 10 two-hour sessions led by a midwife or obstetrician. During the sessions, women receive their prenatal care, engage in self-care activities (such as documenting their own weight and blood pressure), and attend a group discussion of important issues related to prenatal care, childbirth preparation, and postpartum care.
"CenteringPregnancy Plus" offered the same general content and structure of CenteringPregnancy, but three of the 10 sessions included 40 minutes of content related to preventing HIV. The HIV prevention components addressed the participants' perception of HIV risk, personal goals for safer sex behaviors during and after pregnancy, and skills for communicating about safer sex behaviors with sexual partners.
Study participants receiving standard individual prenatal care met with their health care providers on the same schedule and the same number of times as women in the other two care groups, but they only spent about 10-15 minutes with their prenatal care provider per appointment, as is considered standard.
After the initial assessment, the researchers conducted follow-up interviews for all participants during the third trimester, and at six and 12 months after postpartum.
Results of the Study
Participants who received CenteringPregnancy Plus were 51 percent less likely to become pregnant again within six months of giving birth, compared with women in the two other care groups. The CenteringPregnancy Plus program also increased condom use and safe sex communication between partners, and reduced incidences of unprotected sex, compared with the other study treatments.
Teens (ages 14-19) who received CenteringPregnancy Plus had significantly fewer new STIs than teens in the other study conditions (9 percent vs. 12.5 percent of teens in the CenteringPregnancy group and 20 percent in the standard care group). There were no differences in infection rates among young adults (ages 20-25) in the study.
According to the researchers, CenteringPregnancy Plus differs from other HIV interventions by integrating sexual risk prevention into the existing structure of prenatal care, drawing on women's motivations for a healthy pregnancy and their frequent contact with care providers.
Offering an HIV prevention program within the context of prenatal care may help to reduce the spread of HIV and other sexually transmitted infections by reaching an at-risk population that may not otherwise have had access to such programs. The researchers noted that the added time needed to deliver the HIV prevention did not come at the expense of prenatal care. However, they further cautioned that while the program was effective, the differences between groups were modest.
Past research has shown that among teenagers, repeat pregnancy shortly after giving birth increases parenting-related stress and negative parenting behaviors. Thus, by reducing or preventing repeat pregnancies, CenteringPregnancy Plus may help to improve the quality of life of young mothers and their children. The researchers suggest booster sessions of the program may prolong this effect beyond six months postpartum.
The researchers note that pregnancy may be an important window of opportunity to promote changes in behavior and improve the health of women. This study demonstrates the possibility of creating integrated programs that positively influence a wide range of health problems, rather than dealing with each problem separately. Such research may impact the design and delivery of future prenatal care services.
Dr. Ickovics and co-author Trace Kershaw, Ph.D., are conducting a follow-up study, also funded by NIMH, to test the "real-world" effectiveness of CenteringPregnancy Plus when provided through 14 New York City community hospitals and health centers.
Kershaw TS, Magriples U, Westdahl C, Rising SS, Ickovics J. Pregnancy as a window of opportunity for HIV prevention: effects of an HIV intervention delivered within prenatal care. Am J Public Health. 2009 Nov;99(11):2079-86. Epub 2009 Sep 17. PubMed PMID: 19762662.