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Background:  Little is known about the desire of HIV⁺ women to have children and their reproductive decisions. We aimed to assess the fertility and contraceptive choices among HIV⁺ women, and to assess whether the severity of HIV disease influences these choices.

Methods:  In the spring of 2004, 100 HIV⁺ women, aged 18 to 45, from a university HIV clinic, completed a survey on their reproductive history and use of contraceptive methods. We reviewed their medical records for contraceptive methods, ART, and HIV/AIDS diagnoses including CD4 counts and HIV RNA levels. We performed descriptive analysis of population characteristics, and a logistic regression model to predict their desire to have future children.

Results:  Subjects had a median age of 37; 53% were black, 32% white, and 9% Hispanic; 49% were never married, more than half were in a long-term monogamous relationship, and 60% had an HIV^–male partner. With an average of 9 years since diagnosis, 53% had AIDS. Median CD4 count was 471, and 51% had a HIV RNA < 1000 copies; 65% were on ART. Reported condom use increased significantly after HIV diagnosis and of those not sexually abstinent, 89% were currently using condoms. Of the total, 91% had borne children, and 51% had been sterilized (compared with 28% in the general population). Of those who were sexually active but not sterilized, 91% were using reversible contraception. One-third of subjects were considering future children, including 22% of those who had been sterilized. In a multivariable analysis, higher current CD4 count and current non-use of ART were associated with a desire for future childbearing.

Conclusions:  In this clinic setting, HIV⁺ women have reproductive patterns similar to HIV^– women, with most having borne children and many wanting children in the future. They report a high rate of condom use, especially following HIV diagnosis. A high proportion have been sterilized and express sterilization regret, with 22% wanting future children. Potent antiretroviral therapy has greatly improved the outlook for HIV-infected women, even those with an AIDS diagnosis. Since one-third of these HIV⁺ women want to have future children, counseling about reversible methods of contraception must be encouraged.

Keywords: Fertility; Contraception; HIV in Women