Fertility and HIV

Using a sample of HIV-positive women (n=353) and men (n=299) from Nigeria and Zambia as well as their health care providers (n=179), we examine attitudes towards childbearing and abortion among HIV-positive women on individual measures as well as an index. Support for HIV-positive women to have a child was greatest if she was nulliparous or if her desire to have a child was not conditioned on parity and lowest if she already has an HIV-positive child. Support for childbearing among the HIV-positive was found to be lower among HIV-positive women than among HIV-positive men, both of which were lower than support from providers. Support for abortion varied more depending on the measure. Half of all respondents indicated no/low support for abortion on the index measure while between 2 to 4 in 10 respondents were supportive of HIV-positive women being able to terminate a pregnancy. The overall low levels of support for abortion for HIV-positive women indicate that HIV does not seem to qualify for most respondents as a medical condition which justifies abortion. While integrating HIV and family planning services remains challenging, increased medical and social education about childbearing while managing HIV may have the potential to reduce stigma and help HIV-positive individuals meet their reproductive goals.

The exact mechanisms of HIV infection on biological fecundity are not fully understood, but epidemiological evidence provides support for the hypothesis that HIV-positive women have lower pregnancy rates, take longer to become pregnant, and experience higher rates of fetal loss. However, these studies often fail to disentangle behavioral and biological responses to HIV acquisition on reproduction. The present study attempts to isolate the biological effects of HIV infection on fecundity by employing a time-to-pregnancy (TTP) study design. Using contraceptive calendar and HIV serostatus information from 9 Demographic and Health Surveys, we use cox proportional hazard models to assess the relative TTP among HIV-negative and HIV-positive women who desire children. Our analysis demonstrates that HIV-positive women who desire a child present with a longer TTP. The findings from this study can inform reproductive and maternal health program strategies for HIV-positive women, which include ensuring future integration of fertility awareness education, and providing subfertility and infertility diagnostic and management services.

Fertility intentions are strong predictors of eventual fertility, yet little is known about the fertility desires of HIV-infected persons in sub-Saharan Africa. Given the recent and rapid expansion of access to antiretroviral therapy (ART), understanding the fertility intentions, and consequent reproductive health services needs, of men and women living with HIV/AIDS is critical. Emerging evidence on the effect of HIV/AIDS/ART on fertility intentions is mixed with little or no explicit theoretical understanding. This study investigates fertility intentions of PLWHA using mixed methods population-based data collected 2010-11, comprising survey (n=513) and in-depth (n=41) qualitative interviews of PLWHA in Nairobi slums. We show that fertility intentions of PLWHA are fraught with ambivalence and ambiguity due to conflicts between social pressures for biological parenthood and moral pressures to avoid co-infection and future child orphanhood. The implications for reproductive health service provision are explored using in-depth interviews (n=14) with service providers.

While awareness of HIV and AIDS is almost universal in Ghana, the same cannot be said of prevention of mother-to-child transmission (PMTCT) of the disease. This paper assessed the level of knowledge, barriers and attitudes towards PMTCT of HIV/AIDS. Data were gathered through 22 Focus Group Discussions (FGDs) and 29 In-Depth Interviews (IDIs) with People Living with HIV and AIDS, pregnant women and their partners. Research participants were sampled from twelve cities/towns purposively selected from the three ecological zones in Ghana. The inclusion criteria were border towns, commercial/mining towns/cities and towns/cities with high HIV/AIDS prevalence rates. It was found that people have high knowledge about MTCT but fair knowledge about PMTCT. For pregnant women, the most prominent deterring factor is the fear of being diagnosed HIV positive. Creating widespread community awareness of the full set of behaviours necessary to prevent MTCT is an essential step to improve participation in and adherence to interventions that are part of PMTCT programmes.