CHAPTER TWOREVIEWOF RELATED LITERATURE2.1Introduction This section exploresexisting literatures on pregnancy intentions among people living with HIV. Thischapter was discussed under the following sub-headings: conceptual review, empirical review, theoretical review using theory of reasonaction/planned behaviour and summaryof reviewed literatures.
1 PregnancyThe time during whichone or more offspring develops inside a woman is also known as gestation, (Pregnancy ConditionInformation, 2013). Pregnancy can occur either naturally by sexual intercourse or assisted reproductive technology (Shishaand Constanc, 2016). Childbirth typicallyoccurs around 40 weeks from the last menstrual period (LMP)(Pregnancy Condition Information, 2013). When measuredfrom conception itis about 38-40 weeks (Abmanand Steven, 2011). An embryo is the developingoffspring during the first eight weeks following conception, after which, theterm fetus isused until birth. Symptoms of early pregnancy may include missed periods,tender breasts, nauseaand vomiting, hunger, and frequent urination. Pregnancymay be confirmed with a pregnancytest. Pregnancyis divided into three trimesters.
The first week to the 12th week ofconception is known as first trimester (PregnancyCondition Information, 2013). Pregnancy issaid to occur when the sperm fertilizes the egg. The fertilizedegg then travels down the fallopiantube and attaches to the inside of the uterus, where itbegins to form the embryo and placenta. Thefirst trimester has the highest risk abortion (The Johns Hopkins Manual of Gynecology and Obstetrics,2012). Fromweek 13 through 28 is known as the third trimester. Movement of the fetus may be felt around the middle of the second trimester, at28 weeks, most babies can survive outside of the uterus withhigh-quality medical care. The third trimesteris usually from 29 weeks to 40 weeks (Pregnancy Condition Information, 2013). Of the 213 million pregnancies that occurred in 2012, 190 millionwere in the countries and 23 million were in the developedcountries (Sedgh, Singh and Hussain,2014).
Theage group of 15 to 44 has a pregnancy rate of 133 per 1,000 women (Sedgh,Singh and Hussain, 2014). About10% to 15% of these pregnancies end in miscarriage (The Johns Hopkins Manual ofGynecology and Obstetrics, 2012). Complications ofpregnancy resulted in 293,000 deaths in 2013, down from 377,000 deaths in 1990. Common causes include maternalbleeding, complications of abortion,high blood pressure of pregnancy, maternalsepsis, and obstructedlabor (Global Burden ofDisease, 2013). Globally, 40% of pregnancies are unplanned and halfof the unplanned pregnancies are aborted(Sedgh,Singh and Hussain, 2014). 2.
2.2 Human ImmunodeficiencyVirus (HIV) Human immunodeficiency virus (HIV), it is a virus thatinfects humans like influenza and hepatitis. However, HIV is exceptional inthree ways: (i) it mainly targets certain cells of the immune system, (ii) it islethal to the host cell and (iii) it mutates very rapidly. HIV is not just onestrain of virus; it can be divided into two major types, HIV-1 and HIV-2.
HIV-1viruses may be classified into four groups, M, N, O and P (Cavidi, 2012). TheHIV-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 subtypesand circulating recombinant forms (CRFs). There are nine group M subtypes andmore than 50 CRFs known today (Cavidi, 2012). As the virus continues toproliferate and mutate, new subtypes and CRFs will appear. Infection with HIVoccurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breastmilk. Within these bodily fluids, HIV is present as both free virus particlesand viruses within infected immune cells (Cavidi, 2012). The three major routesof transmission are unprotected sexual intercourse, contaminated needles andtransmission from an infected mother to her baby at birth, or through breastmilk (Cavidi, 2012).
HIV mainly targets CD4 cells. The virus invades the host celland uses it to produce more viruses before destroying the cell. When HIV isactive, an exponential effect takes place. It is only a matter of time beforethe CD4 population is rendered to such a low level that they are completelyineffectual. HIV infection leads to low levels of CD4 cells through three mainmechanisms: 1) the virus killing its host cell directly; 2) increased rates ofself-destruction (apoptosis) in infected cells; and 3) killing of infected CD4cells by immune cells (CD8 lymphocytes) that recognize and kill infected cells(Cavidi, 2012).