Perinatal transmission of HIV infection presents a high risk situation for both the mother and the baby, and often has tragic consequences. Yet, to date, there have been no studies of the extent to which women at increased risk of HIV infection are aware of the relationship between AIDS and pregnancy, nor have there been any systematic studies of the impact of knowing one is at increased risk of HIV infection on immediate and future fertility-related behaviors. The objective of this study is to begin to fill this gap in our understanding by investigating: how awareness of, or risk for, HIV infection affect fertility-related behavior among pregnant and postpartum women who demographically are at increased risk of HIV infection (urban, economically disadvantaged Black women); and the impact of being informed while pregnant that one is at increased risk of HIV infection on fertility-related behavior among these women. A prospective study will be undertaken with a panel of pregnant women receiving care at the Johns Hopkins Hospital obstetrical clinic. Two-hundred thirty-five women who are identified as higher risk for HIV infection based on screening questionnaires will be interviewed prenatally. Of these, 113 will be women who refuse blood testing, 101 who test seronegative, and 21 who test seropostive. In addition, 231 lower risk women will also be interviewed prenatally. All women will be interviewed at 12 months postpartum. The framework for the interviews draws on psychosocial work in risk perceptions and decision-making under conditions of uncertainty. Results of the study will describe: what disadvantaged minority women who are pregnant understand about AIDS, HIV infection, HIV testing and their relationships to pregnancy and sexual behavior; the fertility-related behaviors of these women, with a particular focus on contraceptive practices, plans for pregnancy, and plans for family size; and the extent to which perceptions of AIDS and knowledge of one's risk status results in changes in these fertility-related behaviors.
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