CHAPTER until birth. Symptoms of early pregnancy may include



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This section explores
existing literatures on pregnancy intentions among people living with HIV. This
chapter was discussed under the following sub-headings:  conceptual review, empirical review, theoretical review using theory of reason
action/planned behaviour and summary
of reviewed literatures.

2.2 Conceptual

2.2.1 Pregnancy

The time during which
one or more offspring develops inside a woman is also known as gestation, (Pregnancy Condition
Information, 2013).  Pregnancy can occur either naturally by sexual intercourse or assisted reproductive technology (Shisha
and Constanc, 2016). Childbirth typically
occurs around 40 weeks from the last menstrual period (LMP)
(Pregnancy Condition Information, 2013).  When measured
from conception it
is about 38-40 weeks (Abman
and Steven, 2011). An embryo is the developing
offspring during the first eight weeks following conception, after which, the
term fetus is
used until birth. Symptoms of early pregnancy may include missed periods,
tender breasts, nausea
and vomiting, hunger, and frequent urination. Pregnancy
may be confirmed with a pregnancy

is divided into three trimesters. The first week to the 12th week of
conception is known as first trimester (Pregnancy
Condition Information, 2013).  Pregnancy is
said to occur when the sperm fertilizes the egg. The fertilized
egg then travels down the fallopian
tube and attaches to the inside of the uterus, where it
begins to form the embryo and placenta. The
first trimester has the highest risk abortion (The Johns Hopkins Manual of Gynecology and Obstetrics,
2012).  From
week 13 through 28 is known as the third trimester. 
Movement of the fetus may be felt around the middle of the second trimester, at
28 weeks, most babies can survive outside of the uterus with
high-quality medical care. The third trimester
is usually from 29 weeks to 40 weeks (Pregnancy Condition Information, 2013).  
Of the 213 million pregnancies that occurred in 2012, 190 million
were in the countries and 23 million were in the developed
countries (Sedgh, Singh and Hussain,

age group of 15 to 44 has a pregnancy rate of 133 per 1,000 women (Sedgh,
Singh and Hussain, 2014).  About
10% to 15% of these pregnancies end in miscarriage (The Johns Hopkins Manual of
Gynecology and Obstetrics, 2012).  Complications of
pregnancy resulted in 293,000 deaths in 2013, down from 377,000 deaths in 1990. Common causes include maternal
bleeding, complications of abortion,
high blood pressure of pregnancy, maternal
sepsis, and obstructed
labor (Global Burden of
Disease, 2013). Globally, 40% of pregnancies are unplanned and half
of the unplanned pregnancies are aborted
Singh and Hussain, 2014).  

 2.2.2 Human Immunodeficiency
Virus (HIV)

 Human immunodeficiency virus (HIV), it is a virus that
infects humans like influenza and hepatitis. However, HIV is exceptional in
three ways: (i) it mainly targets certain cells of the immune system, (ii) it is
lethal to the host cell and (iii) it mutates very rapidly. HIV is not just one
strain of virus; it can be divided into two major types, HIV-1 and HIV-2. HIV-1
viruses may be classified into four groups, M, N, O and P (Cavidi, 2012). The
HIV-1 group M viruses are the most common ones, and have caused more than 90%
of all known HIV infections. Group M can be further subdivided into subtypes
and circulating recombinant forms (CRFs). There are nine group M subtypes and
more than 50 CRFs known today (Cavidi, 2012). As the virus continues to
proliferate and mutate, new subtypes and CRFs will appear. Infection with HIV
occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast
milk. Within these bodily fluids, HIV is present as both free virus particles
and viruses within infected immune cells (Cavidi, 2012). The three major routes
of transmission are unprotected sexual intercourse, contaminated needles and
transmission from an infected mother to her baby at birth, or through breast
milk (Cavidi, 2012).

HIV mainly targets CD4 cells. The virus invades the host cell
and uses it to produce more viruses before destroying the cell. When HIV is
active, an exponential effect takes place. It is only a matter of time before
the CD4 population is rendered to such a low level that they are completely
ineffectual. HIV infection leads to low levels of CD4 cells through three main
mechanisms: 1) the virus killing its host cell directly; 2) increased rates of
self-destruction (apoptosis) in infected cells; and 3) killing of infected CD4
cells by immune cells (CD8 lymphocytes) that recognize and kill infected cells
(Cavidi, 2012).