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A. D. Forsyth, PhD

Andrew D. Forsyth is with the National Institute of Mental Health, National Institutes of Health.

Correspondence: Requests for reprints should be sent to Andrew D. Forsyth PhD, National Institute of Mental Health, National Institutes of Health, 6001 Executive Blvd., Rm. 6201, MSC 9619, Bethesda, MD 20892 (e-mail: aforsyth{at}mail.nih.gov).

We thank Chen for correctly pointing out a lack of precision in sections of our manuscript¹ regarding an interpretation of a multiple logistic regression model of pregnancy outcomes 6 months after HIV diagnosis among women in 2 developing countries. We hope that our global interpretation of a statistical analysis of women’s intentions to become pregnant and HIV diagnosis is mitigated in 2 ways. First, we reported no univariate differences in women’s pregnancy outcome by HIV diagnosis in Table 2 of our paper. Second, in the results section, we interpreted properly the interaction coefficients showing that, "women who had received a recent HIV diagnosis and had expressed the intention to become pregnant before HIV testing were less likely to be pregnant at follow-up." We appreciate the opportunity to clarify that the positive relationship between pregnancy outcome and HIV diagnosis observed in Table 3 pertained only to those without pregnancy plans before receiving voluntary HIV counseling and testing (VCT), and not to all women in the study.

Chen takes issue with our claim that "HIV diagnosis may influence reproduction planning for women but not for men," arguing that the "men and women show very similar patterns." Determining the statistical significance of these differences would require testing models that included gender with and without gender interactions. We did not pursue this route. We acknowledge that there were broad, qualitative similarities between men and women in our analyses, but we maintain that the quantitative findings indicated that the interaction effects of pregnancy intentions and HIV diagnosis were statistically significant for women but not for men.

We concur with Chen that regression models with interaction terms require careful interpretation of generated coefficients and great precision in communicating complex results to readers.

Reference

1. Forsyth A, Coates T, Grinstead O, et al. HIV infection and pregnancy status among adults attending voluntary counseling and testing in 2 developing countries. Am J Public Health. 2002;92(11):1795–1800.[Abstract/Free Full Text]

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