Resumption of sexual activity and regular menses after childbirth among women infected with HIV in Malawi

Objective: To determine the factors associated with resumption of sexual activity and regular menses after childbirth among women infected with HIV-1. Methods: Information on sociodemographic, behavioral, and clinical factors was obtained from 2 HIV perinatal studies (NVAZ and PEPI trials) conducted in Malawi, 2000-2009. Factors associated with resumption of sexual activity and menses were analyzed using Cox proportional hazard models. Results: A total of 1838 women from the NVAZ study and 2982 women from the PEPI study were included in the analysis. Resumption of sexual activity was primarily associated with sociodemographic factors (e.g. in the PEPI study, marital status [adjusted hazard ratio (aHR) 0.56, P < 0.001], use of contraceptive method [aHR 8.0, P < 0.001], and breastfeeding [aHR 0.52, P < 0.001]), whereas resumption of regular menses in the PEPI study was primarily associated with biological factors (e.g. plasma viral load [aHR 0.89, P < 0.006], and breastfeeding [aHR 0.23, P < 0.001). Conclusion: HIV-infected women need adequate counseling to take into account their HIV infection status before resuming sexual activity after childbirth.