INTRODUCTION:
HIV/AIDS affects approximately 39 million people, with nearly two-thirds residing in sub-Saharan Africa (SSA). In most SSA countries, abortion is illegal and restricted. Nonetheless, clandestine abortions persist, often performed by unqualified individuals or under unsafe conditions, leading to high maternal morbidity and mortality. Women living with HIV (WLHIV) face unique reproductive health challenges, including heightened health risks from unsafe procedures.

METHODS:
This study examines cross-national variations, individual and contextual factors influencing pregnancy termination among WLHIV in SSA. Using pooled Demographic and Health Survey (DHS) data from 28 SSA countries, a multilevel logistic regression analysis was conducted to account for the data's hierarchical structure.

RESULTS:
Results indicate a significant association between HIV status and abortion, and socio-demographic factors play key roles among WLHIV. Predictors of abortion among WLHIV include age, marital status, education, total children ever borne, fertility preference, wealth, number of sex partners in a year and lifetime, age at first sex, community wealth, wealth level in the country, region of Africa, and fertility level in the country. Despite condoms being recommended for WLHIV as a dual protection method to prevent transmission and conception, their use is not associated with significantly lower abortion.

CONCLUSIONS:
The three-level analytical model, adjusting for the role of fertility intention and dual protection of contraceptive, cluster-level, and country-level variables, produces a better fit to understand the role of socio-demographic factors on abortion among WLHIV. It identifies notable contextual effects, highlighting similarities and variations within and across communities and countries. Within-level and cross-level interactions underscore the complexity of abortion dynamics among WLHIV in SSA.