Unintended pregnancy among women living with HIV in Cross River State, Nigeria: prevalence, associated factors, and implications for HIV prevention

BACKGROUND: Unintended pregnancy is common with unprotected sexual intercourse. Women living with HIV (WLH) are more likely to have unintended pregnancies with implications for vertical HIV transmission and negative health outcomes. Hence, there is a need to investigate unplanned pregnancy among WLH in an HIV burdened state in Nigeria. This study aimed to assess the prevalence and factors associated with unintended pregnancy among WLH in Cross River State, Nigeria. METHODS: Between June and August 2024, we conducted a cross-sectional study in four purposively selected health facilities. We asked 893 WLH if they had ever been pregnant when they did not want to and analyzed the data using SPSS version 29. We assessed factors associated with unintended pregnancy using logistic regression. RESULTS: The WLH were on average 33.9 years old. About 61% were on modern contraceptives, mainly male condoms (37.6%). Unintended pregnancy was 49.2%; it was more common among those with increasing religiosity level (AOR: 1.239; 95% CI: 1.099-1.396), those who did not engage in transactional sex in the past year (AOR: 8.660; 95% CI: 2.338-32.079), and those without a history of miscarriage (AOR: 3.866; 95% CI: 1.583-9.445). Lastly, WLH with higher household incomes were less likely to report unintended pregnancy (AOR: 0.177; 95% CI: 0.042-0.738). CONCLUSION: Unintended pregnancy was high among WLH. Stakeholders must educate WLH and sensitize religious leaders about the need to encourage modern contraceptive use to reduce the risk of unintended pregnancy among WLH. These findings have implications for the prevention of mother-to-child HIV transmission and maternal deaths, of which Nigeria has one of the highest rates globally.