A majority of women receiving care at an HIV clinic in Nashville did not use any form of contraception, and pregnancy rates were high, according to a study published in Open Forum Infectious Diseases.

These findings suggest that “continued efforts to ensure access to effective contraception options are needed in HIV clinics,” study authors Manasa Bhatta, of Vanderbilt University, and colleagues concluded.

Women make up nearly a quarter of people living with HIV in the United States and accounted for 19% of new HIV diagnoses in 2019. A majority of newly diagnosed women are of reproductive age, but previous research has shown that contraception use among women with HIV is low, and more than half of pregnancies are unintended. Unplanned pregnancy is associated with poor HIV and mental health outcomes, the researchers noted as background.

What’s more, women who don’t plan their pregnancies may miss out on appropriate prenatal care to prevent mother-to-child HIV transmission.

Bhatta’s team analyzed contraception use among women who received care at the Vanderbilt Comprehensive Care Center in Nashville between 1998 and 2018. The clinic provides primary and specialty care for people living with HIV, including screening for sexually transmitted infections and cervical cancer, family planning services and prenatal care. For most women, this serves as their primary care clinic.

The study authors suggested that several factors may contribute to this low contraception use, including hesitancy to discuss family planning—possibly reflecting the fact that HIV-positive women were previously often advised to use permanent contraception methods.

Concerns about using antiretrovirals and hormonal contraception together may also contribute to hesitancy among patients and providers, they added. However, HIV treatment guidelines from the Department of Health and Human Services state that all HIV-positive women who are sexually active and don’t desire pregnancy should be offered contraception and can use all available methods after consideration of potential drug interactions.