Are women with complications of an incomplete abortion more likely to be HIV infected than women without complications?

Carolyn Othieno, Joseph B. Babigumira, Barbra Richardson

There is limited published evidence about the status of HIV among women who have had abortions or suffered from abortion complications. Understanding this connection is critical for building the evidence base and for guiding strategies to manage the sexual and reproductive health needs of women living with HIV. The purpose of this study is to determine whether women who suffered incomplete abortion complications are more likely to be HIV infected than those without complications. We hypothesized that women with incomplete abortion complications have higher rates of HIV infection than women who attended clinic for other obstetric reasons. The analysis used a secondary dataset from a published case-control study that enrolled 1) 70 women at discharge after receiving in-patient care for complications resulting from induced abortion, and 2) 69 women (the comparison group) who visited the same hospital during the same time period for other obstetric needs. The primary outcome was seeking care for complications of incomplete abortion versus seeking care for other obstetric needs (dichotomous). The primary exposure variable was self-reported HIV status which was categorized into three groups: HIV positive, HIV negative, and HIV unknown. Unadjusted and adjusted associations between being in the abortion complications group, HIV status and other selected population characteristics were estimated using univariate and multivariate logistic regression. Of 139 women enrolled in this study. Seventy (50.4 %) women had abortion complications and 69 (49.6 %) did not. Of the total study population, 18 (12.9 %) were HIV positive, 50 (36.0 %) were HIV negative, and the HIV status of 71 women (51.1 %) was unknown. Compared to women who were HIV negative, women who were HIV positive had similar odds of being in the abortion complications group in both univariate and multivariate analyses (ρ =0.62 and ρ = 0.76). However, compared to HIV-negative women, those women who did not know their HIV status had greater odds of being in the abortion complications group (OR = 3.8, 95 % CI, 1.88, 8.20) in univariate analysis. After adjusting for potential confounding variables, the odds of being in the abortion complications group remained greater among women who did not know their HIV status compared to HIV-negative women (adjusted OR = 2.8, 95 % CI, 1.20, 6.54). This study points to the need for targeted interventions aimed at strengthening the delivery and coverage of HIV-testing programs for pregnant women and post-abortion care. In addition, more research is needed to better understand the relationships between unsafe abortion, abortion complications and unknown HIV status.