416 J Health Popul Nutr Dec 2006 infection, or gonorrhoea (15). WHO also says that initia- tion of IUD use should generally not be considered for women with AIDS, unless they are clinically well on antiretroviral therapy, because potential risks usually outweigh the advantages of using the method (15). Some drugs used to treat opportunistic infections, such as tuberculosis, may reduce the effectiveness of some oral contraceptives (16). As more women gain access to antiretroviral therapy, they also need to be informed that some antiretroviral medications may decrease the effec- tiveness of oral contraceptives, while oral contraceptives may increase or decrease concentrations of antiretrovi- ral drugs (17-19). WHO recommends that women on antiretroviral therapy who use hormonal contraceptives also use condoms (15,20), while the U.S. Department of Health and Human Services recommends that women taking certain antiretroviral drugs consider an alternative or additional method to oral contraception (17). The literature showed that a few NGOs had pub- lished information materials that address interactions of such drugs (21-24). However, because one of their primary goals is to prevent transmission of HIV, vari- ous AIDS programmes mainly promoted use of male condoms and paid little attention to women-controlled methods to prevent pregnancy (25-28). Such observa- tions have led to increasing calls to better integrate fami- ly-planning and HIV/AIDS programmes (11,29,30), although it has also been pointed out that research is need- ed on how such integration can best be achieved (31). A policy brief published in September 2005 pointed out that HIV-positive women still face many barriers in ac- cessing a wide range of contraceptive services and opti- ons appropriate to their needs (32). Given the afore-mentioned barriers and the exist- ence of contraceptive failures, it is important that HIV- positive women have access to emergency contracep- tion. Emergency contraception is available in many countries, but reports show that familiarity of women with, and access to, emergency contraception varies widely and can be quite low in countries as diverse as Canada, Russia, and South Africa (33-35). In Ja- maica, pharmacists asked the Ministry of Health to reconsider over-the-counter availability of emergency contraception because they believe that it is over-used and led to declining sales of condoms (36). Abortion-related care While some studies on HIV and pregnancy in the litera- ture reviews reported on pregnancy-related complica- tions and percentages of women suffering miscarriages and stillbirths, almost none had specifically investigated induced abortion among HIV-positive women. Some Bruyn M researchers do not distinguish spontaneous from induced abortions when discussing pregnancy outcomes. In coun- tries with restrictive abortion laws, hospitals may fail to record induced abortions (37) so that retrospective stud- ies using hospital charts may have inadequate data. Data available on miscarriages and induced abortions among HIV-positive women are, therefore, likely to be incomplete. Cases of coercion and pressure to terminate preg- nancies emerged in research on other issues and also in newspaper reports (38-45). Some studies reported that women living with HIV would want to or were terminat- ing unwanted pregnancies, even when there were nu- merous legal restrictions on abortion (46,47). Reports published since the literature reviews were done have also documented such cases (48,49). Initiatives to better integrate family-planning and HIV/ AIDS programmes should address what HIV-positive women can do to deal with unwanted pregnancies result- ing from contraceptive failure. Up to 2005, safe legal abor- tion was infrequently mentioned, although WHO and the international guidelines on HIV/AIDS and human rights issued by UNAIDS and the Office of the High Commis- sioner for Human Rights support the right of women liv- ing with HIV and AIDS to have access to safe abortion where allowed by law (50-52). A few international and national NGOs are beginning to address the rights of HIV- positive women to exercise choice in regulating their fer- tility (53-57), but their numbers remain limited. Adoptive parenting As access to antiretroviral therapy increases, HIV in- fection is becoming a more chronic rather than a fatal condition for many women and men. In this context, if cultural norms and social policies were to accept HIV- positive people as adoptive parents, some might choose to adopt rather than have their own biological children. This would require addressing cultural expectations and norms about parenting, family lineages, and inheri- tance that may be difficult to change. For example, fo- cus-group participants in Malawi reported that, while childless couples might foster children, they might not receive the same respect as other parents (58). Never- theless, work being done to alter norms about sexuality shows that such a change is possible. Some HIV-positive women and men have indicated that they want to consider legal adoption. The topic of adoption occasionally appears on e-mail discussion groups for people living with HIV. A study among 250 HIV-posi- tive men in São Paulo, Brazil, found that, while 52% wanted no (more) children and 5% were unsure, 43% did want (more) children in the future; 4% said that they would like to adopt a child (59).