Measuring time to pregnancy in HIV+ women: Results from Demographic and Health Surveys

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.