Purpose: To compare pregnancy incidence between HIV infected and HIV uninfe
cted adolescents over a 3-year period and to characterize factors that diff
erentiate pregnant from nonpregnant HIV infected females.
Methods: Female adolescents enrolled in Reaching for Excellence in Adolesce
nt Care and Health (REACH), a national cohort study, and nonpregnant at bas
eline comprised the sample (it = 345). Subject information on pregnancy, ri
sk behavior, and psychosocial characteristics was obtained through intervie
w, chart review, physical examination and laboratory data collected every 3
months. Incident pregnancy rate was analyzed using Cox proportional hazard
s modeling; the predictors of incident pregnancy were evaluated using repea
ted measures analysis.
Results: Ninety-four pregnancies were identified over 3 years. No significa
nt difference in pregnancy incidence was detected between HIV infected and
uninfected females (20.6 and 28.4 per 100 person-years, respectively, p =.1
6). However, for adolescents with living children at entry, HIV infected fe
males were significantly less likely to become pregnant than HIV uninfected
(HR =.45; p =.03). Among HIV infected adolescents, significant predictors
of incident pregnancy were older age (p =.01) and not using hormonal contra
ception (p =.00), whereas increased spiritual hope and passive problem-solv
ing capacity were protective against pregnancy (p =.02, and .05, respective
ly). Multivariate analysis revealed pregnancy prior to study entry to be pr
edictive for (OR = 3.0; 95% CI: 1.2-7.7), and increased spiritual hope to b
e protective (OR = .4; 95% CI:.2-.9) against incident pregnancy in HIV infe
cted females without the hormonal contraceptive variable in the model.
Conclusions: The pregnancy rate is high in this study population. Further r
esearch is needed into its determinants and attenuating factors, particular
ly the role of spiritual elements, to design better contraceptive services
and reproduction-related education targeting high-risk youth. Society for A
dolescent Medicine, 2001.