Experience and outcome of pregnancy among women living with HIV in the UK: impact of ethnicity and African region of origin

In recent years there has been a steady increase in the number of pregnant women with HIV in the UK, the majority (80%) born in Sub-Saharan Africa. This will be the first study to explore the experience of pregnant African women living with HIV in the UK.
Interventions, including the use of anti-HIV medication, have dramatically reduced the transmission of HIV from mother to baby. During the first part of the study, existing UK databases on HIV and pregnancy will be analysed to examine the impact of African ethnicity and region of origin on the success of these interventions and return for HIV care after delivery. So far, the data have only been analysed according to ethnicity. Given the diversity of African cultures, grouping countries into regions may be more appropriate.
The second part of the study will be conducted in three London HIV clinics. Approximately forty pregnant African women with HIV will be interviewed to explore their experience of pregnancy and attitudes towards medical care.
This project will provide an insight into HIV-positive African women‘s experience of pregnancy in the UK and help healthcare providers to develop appropriate and supportive medical services for this group of women.

In recent years there has been a steady increase in the number of pregnant women with HIV living in the UK, rising from 80 in 1990 to 1300 in 2006. This trend is expected to continue. The majority (80%) of these women were born in sub-Saharan Africa. The overall aim of this proposal is to examine whether ethnicity and African region of origin have an impact on the outcome and experience of pregnancy among HIV-positive women living in the UK. To pursue this aim, we propose a collaboration between two universities (City University London; University College London) and three hospital trusts (Homerton; Newham; Guy‘s and St Thomas‘). We will undertake the research in two phases using quantitative and qualitative research methods.

In the first phase, the applicant (Shema Tariq) will analyse epidemiological data from two HIV pregnancy databases; (i) the National Study of HIV in Pregnancy and Childhood surveillance database with data on 8500 HIV positive pregnant women in the UK; (ii) the European Collaborative Study prospective cohort database with data on 8000 mother-child pairs in 10 European countries. The objective of the first phase is to examine the relationship between ethnicity/African region of origin and clinical outcomes including maternal HIV viral load at delivery, pregnancy outcome and infant HIV status. A further objective will be to ascertain the extent to which missing data introduce bias in these HIV-and-pregnancy databases.

In the second phase, the applicant will conduct qualitative interviews with 30 HIV positive pregnant black African women attending antenatal clinics in the collaborating hospitals. The objective of the second phase is to examine, for the first time in the UK, the experience of pregnancy and ante-natal care among this group and to look at the impact of region of origin on variables such as attitudes towards HAART, use of alternative therapies and models of healing.

This collaborative research project will provide an int into HIV positive African women‘s experience of pregnancy in the UK and allow health care providers and policy makers to develop appropriate and supportive antenatal services for this group of women. This intellectually challenging and multidisciplinary project will also provide training and a solid grounding in both quantitative and qualitative research methods for the applicant.