目的：了解育龄期女性人类免疫缺陷病毒（human immunodeficiency virus, HIV）感染者乐观水平现状及其影响因素，为促进女性HIV感染者综合管理提供参考。方法：采用便利抽样法选取2023年12月至2024年6月在广州市某定点医院感染门诊就诊的育龄期女性HIV感染者。采用一般资料调查表、修订版生活定向测试（Revised Life Orientation Test, LOT-R)和医学应对方式问卷（Medical Coping Modes Questionnaire，MCMQ）进行问卷调查。采用SPSS 26.0软件进行非参数检验和多元线性回归分析。结果：最终纳入185例育龄期女性HIV感染者，乐观水平总分为22.00（19.00，25.00）分，乐观维度得分为13.00（11.00，15.00）分，悲观维度得分为9.00（7.00，11.00）分。多元线性回归分析结果显示，独生女（β=−0.151）、因HIV感染改变生育意愿（β=−0.141）与LOT-R得分呈负相关，居住地（β=0.165）、有生育史（β=0.171）与LOT-R得分呈正相关，差异均有统计学意义（P<0.05）。结论：育龄期女性HIV感染者乐观水平处于中等水平，应关注独生女、居住在农村、无生育史的患者。建议将家庭系统干预作为缓解独生女角色压力的关键切入点；利用数字化工具拓展远程支持，以缩小农村感染者的地域与信息差距；因为有生育困惑者提供整合心理与医学的决策咨询，从而全方位提升该群体的心理健康与生育信心。

Objective To investigate the status and influencing factors of optimism among reproductive-aged women with human immunodeficiency virus (HIV), aiming to provide a reference for promoting the comprehensive management of female HIV patients. Methods The convenience sampling method was used to select reproductive-aged women with HIV who attended the infectious disease outpatient clinic of a designated hospital in Guangzhou from December 2023 to June 2024. General information questionnaire, Revised Life Orientation Test (LOT-R), and Medical Coping Modes Questionnaire (MCMQ) were used for the survey. Non-parametric tests and multiple linear regression analysis were conducted using SPSS 26.0 software. Results A total of 185 reproductive-aged women with HIV were included. The total LOT-R score was 22.00（19.00, 25.00） points, with the optimism dimension score being 13.00(11.00, 15.00) points and the pessimism dimension score being 9.00(7.00, 11.00) points. Multiple linear regression analysis results showed that being an only child (β=−0.151) and having changed fertility intentions due to HIV infection (β=−0.141) were negatively correlated with LOT-R scores, while place of residence (β=0.165) and having a history of childbirth (β=0.171) were positively correlated with LOT-R scores. All correlations exhibited statistical significance (P < 0.05). Conclusions The level of optimism among reproductive-aged women with HIV is moderate. Attention should be given to patients who are the only children, reside in rural areas, or have no history of childbirth. It is recommended to use family system intervention as a key entry point to alleviate the role pressure of only daughters; utilize digital tools to expand remote support to narrow the geographical and information gap for rural patients; and provide integrated psychological and medical decision-making counselling for those with fertility-related concerns, thereby comprehensively enhancing the mental health and fertility confidence of this population.