Meta-analyses of fertility desires of people living with HIV

Fertility desires of antiretroviral therapy-attending HIV-positive women and its associated factors in Harari region, Ethiopia

BACKGROUND

The desire to have children among mothers living with HIV remains a serious public health issue in nations with low coverage for antiretroviral therapy and the prevention of mother-to-child transmission, even if it is feasible to have an HIV-negative child. Therefore, this study aimed to assess fertility desire and associated factors among antiretroviral therapy-attending HIV-positive women at Hiwot Fana Specialized University Hospital, in Harari, Ethiopia.

METHODS

A facility-based cross-sectional study design was employed among 639 anti retro-viral therapy attending HIV - positive women by systematic random sampling method selected from June 15 to November 30, 2020. A binary logistic regression model was fitted to identify the associated factors with fertility desire. Descriptive results were presented in percentages, whereas analytical results were reported in adjusted ORs (AORs) with a 95% CI. At p=0.05, statistical significance was declared.

RESULTS

A total of 639 participants were included in the study; 69.5%(95% CI 65.7 to 72.9%) of the participants had fertility desire. Younger age (<35 years) (AOR=2.35, 95% CI 1.27 to 4.35), married women (AOR=3.02, 95% CI 1.32 to 12.25), childless women (AOR=2.86, 95% CI 1.17 to 4.82) and women whose duration of HIV diagnosis was ≤5 years (AOR=0.41, 95% CI 0.20 to 0.71) were significantly associated with fertility desire.

CONCLUSION

The majority of the study participants have a desire to have children. In light of the high prevalence of fertility desire among antiretroviral therapy-attending HIV-positive women, it is recommended to counsel younger women on reproductive planning and encourage partner testing.

Parenting intentions of young sexual minority men living with HIV in Mexico City, Mexico

Young sexual minority men are disproportionately affected by HIV in Mexico. Little is known about their thoughts about childbearing, an issue complicated by sexual identity and HIV serostatus. We conducted 16 in-depth qualitative interviews to explore the parenting desires of young sexual minority men living with HIV in Mexico City. Domains of the questionnaire included (1) parenting desires, (2) preferences about different methods (e.g. adoption, in-vitro fertilisation), and (3) perceived barriers to becoming a father. A modified grounded theory approach was used for qualitative analysis. Participants ranged in age from 17 to 21 years and had been living with HIV for an average of 15 months. Most expressed the desire to have a child in the future but were uninformed as to their options for doing so. Participants largely preferred adoption, citing the perceived risk of HIV transmission as a deterrent to using assisted reproductive technologies. Some participants expressed the desire to have a child that was genetically their own, but shared doubts as to the feasibility. The majority of participants stated that the topic of childbearing had never come up during the course of their HIV care.

Experiences With Safer Conception Services for HIV-Serodiscordant Couples at a Referral Hospital in Nairobi, Kenya

Human immunodeficiency virus-serodiscordant couples are an important source of new HIV infections in Africa. When trying to conceive, uninfected partners may be at high risk of infection if the infected partner is not virally suppressed. Multiple strategies targeting safer conception exist, but these services are limited. However, when services are available and used, serodiscordant couples can be protected from HIV transmission, and safe to have children if desired. To successfully introduce, integrate, promote, and optimize the service delivery of safer conception with HIV care, it is crucial to understand how HIV-serodiscordant couples perceive and experience these services. Further, viral load monitoring can be critical to safer conception, but there is limited literature on how it informs the decision of the partners about conception. This qualitative study describes the knowledge, perceptions, and experiences of both safer conception services and viral load monitoring among 26 HIV-serodiscordant couples seeking safer conception care at a referral hospital in Nairobi, Kenya. In-depth interviews of HIV-serodiscordant couples were conducted from April to July 2017, and transcripts were analyzed to identify the themes central to the experience of safer conception services of couples and viral load monitoring. Serodiscordant couples reported success in using some of the safer conception methods and had positive experiences with healthcare providers. However, despite using the services, some were concerned about HIV transmission to the seronegative partner and baby, while others faced challenges when using pre-exposure prophylaxis (PrEP) and vaginal insemination. Overall, their motivation to have children overcame their concern about HIV transmission, and they welcomed discussions on risk reduction. Moreover, supportive clinic staff was identified as key to facilitating trust in safer conception methods. Furthermore, viral load monitoring was identified as integral to safer conception methods, an emerging theme that requires further evaluation, especially where routine viral load monitoring is not performed. In conclusion, healthcare providers offering safer conception services should build trust with couples, and recognize the need for continual couple counseling to encourage the adoption of safer conception services.

Current fertility desire and its associated factors among currently married eligible couples in urban and rural area of Puducherry, south India

Background

There are paucity of studies on current fertility desire at community level.

Objective

To assess current fertility desire and its associated factors among eligible couples of reproductive age group in Puducherry, India.

Methods

A community-based cross-sectional study from 2016 to 2017 among 2228 currently married eligible couples assessed socio-demographic and fertility-related factors associated with fertility desire. Data were collected based on the National Family Health Survey questionnaire. Association of fertility desire was assessed by univariate and generalised linear regression analysis.

Results

Out of 1979 respondents, current fertility desire within two years was 13.7% (95% CI, 12.3%–15.3%). Mean number of children (SD) currently living and preferred was 1.77(0.851) and 2.11 (0.528) respectively. After adjusting for confounders, the significant factors positively associated with fertility desire include woman's age of 18–24 (APR = 2.91), 25–29 years (APR=2.48), 30–34 (APR=2.47), 35–39(APR=2.06), high socioeconomic status (APR=2.02), those without child (APR=52.35) and those with one child (APR=35.60).

Conclusion

The fertility desire is comparatively lesser than other areas. Those without or with a single child and high socioeconomic status group had comparatively more fertility desire.

Fertility intentions of women living with HIV and their male partners during the perinatal period in rural South Africa

Understanding the fertility intentions of people living with HIV can guide safer conception planning and prevention of mother-to-child transmission (PMTCT). Most research has addressed fertility intentions among women, rather than couples, at a single time point. This clinical trial of a PMTCT intervention in rural Mpumalanga province, South Africa, examined longitudinal fertility intentions among perinatal women living with HIV and their male partners. Study assessments and intervention and control sessions were conducted prenatally and postpartum. Longitudinal predictors of participants' (n = 360 men, n = 917 women) fertility intentions were similar between sexes. Younger age and male involvement in perinatal care were associated with reporting fertility intentions at both baseline and 12 months postpartum. Having an HIV-positive infant and discussing pregnancy plans with a healthcare provider by 12 months postpartum were associated with incident fertility intentions after reporting no plans for further children at baseline. Results highlight the important role of healthcare providers to educate men and women on issues surrounding conception, as well as the potential for incorporating PMTCT and safer conception education into HIV clinical services.

Prevalence and factors associated with fertility desire among people living with HIV: A systematic review and meta-analysis

BACKGROUND

The fertility desire of people living with HIV (PLHIV) has been rising in the past decade. However, there are many studies among which the association remains controversial between the fertility desire of HIV-infected persons and antiretroviral therapy (ART), sex, marital status, and educational level.

METHODS

We performed a literature search of these meta-analyses in PubMed, the Cochrane Library, Web of Science and ScienceDirect in November 2019. We also reviewed references of eligible studies to complement the search. We used pooled odds ratios (ORs) and 95% confidence intervals (CIs) with a random-effects model and a fixed-effects model to estimate the association between fertility desire among PLHIV and ART, sex, age, marital status, educational level, and number of children. Subgroups with I square values (I2) and sensitivity analyses were performed to assess the heterogeneity and the stability of the overall ORs, respectively. We evaluated publication bias using Egger's test and a visual inspection of the symmetry in funnel plots.

RESULTS

In these meta-analyses 50 articles were included with 22,367 subjects. The pooled prevalence of fertility desire among PLHIV was estimated to be 42.04%. The pooled analyses showed that the fertility desire of PLHIV is associated with ART (OR = 1.11, 95% CI:1.00-1.23, P = 0.043), sex (OR = 1.51, 95% CI:1.10-2.09), age (OR = 2.65, 95% CI:2.24-3.14), marital status (OR = 1.34, 95% CI:1.08-1.66), educational level (OR = 0.85, 95% CI:0.73-1.00, P = 0.047) and the number of children (OR = 3.99, 95% CI:3.06-5.20). PLHIV who are on ART, are male, are younger than 30, are married/cohabiting, have received a secondary education or above, and are childless have a higher prevalence of fertility desire. The two factors of age and the number of children, in particular demonstrated a strong significant association with fertility desire. We found moderate heterogeneity in the meta-analyses of age and educational level and high heterogeneity in the meta-analyses of sex, marital status and number of children. Publication bias was detected in the meta-analyses of the association of fertility with sex and educational level.

CONCLUSION

This study demonstrates that the prevalence of fertility desire among HIV-infected people is 42.04%, and the fertility desire among PLHIV is associated with ART experience, sex, age, marital status, the number of children, and educational level. Since a majority of PLHIV are of reproductive age, it is necessary to support PLHIV in terms of their needs regarding reproductive decision-making. Through counseling and reproductive health care, further measures to prevent the horizontal and vertical transmission of HIV should be taken.

Demography of remarriage and fertility desire among women receiving antiretroviral therapy in South West Nigeria

Background: In view of sociocultural norms surrounding marriage and childbearing in South West Nigeria, fertility desire may be stronger among remarried women living with HIV. This article describes the characteristics of remarriage and its relationship to fertility desire.Method: A cross-sectional study was conducted among HIV-positive women aged 18-49 years at the Antiretroviral Treatment (ART) clinic, College of Medicine/University College Hospital, Ibadan, Nigeria between November and December 2015. Data were analysed using descriptive statistics and generalised linear models.Results: Overall, 123 (17.3%) of 711 women had experienced remarriage. Significant factors among remarried women were a lack of formal education (OR_adj = 3.35, CI: 1.46-7.72); polygamous family (OR_adj = 2.65, CI: 1.71-4.12), and serodiscordant union (OR_adj = 1.97, CI: 1.14-3.41). Fertility desire was expressed by 410 women (57.7%). After controlling for demographic, socio-economic, and HIV-care characteristics, remarried women were 2.5 times as likely to have fertility desire compared to their counterparts who never remarried (OR_adj = 2.49, CI: 1.43-4.33). Younger age was significantly associated with higher odds of fertility desire. Other factors negatively associated with fertility desire were education (OR_adj = 0.30, CI: 0.12-0.74) and number of surviving children (OR_adj = 0.28, CI: 0.22-0.34).Conclusion: HIV-care and treatment programmes need to pay attention to reproductive concerns, especially among women in second and higher order marriages.

Fertility desire and associated factors among people living with HIV in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Increased Anti-Retroviral Therapy (ART) coverage improves health status and the survival of people living with Human Immunodeficiency Virus (HIV) as a result, reproductive health needs of the clients are increased. As part of continuum HIV care, understanding fertility desire and reproductive health care needs of HIV positive peoples will play paramount role in planning and delivering appropriate health services. The finding of studies conducted on the fertility desire and associated factors among People Living with HIV in Ethiopia presented inconclusive. Therefore, this study aimed to assess the pooled prevalence of fertility desire and associated factors among people living with HIV in Ethiopia.

METHODS

A total of 26 studies conducted in Ethiopia were included in this Meta-analysis. Pub Med, HINARI, Google scholar and Google data bases were searched. Data from the included articles were extracted using a standardized data extraction tool. The included studies were analyzed using a random effects meta-analysis model. Analysis was done Using STATA version 14 statistical software. Heterogeneity was assessed statistically using the standard Chi-square, I^2. The association between fertility desire and factors were examined using a random effects model.

RESULT

In this meta-analysis, the pooled prevalence of fertility desire in Ethiopia is 42.21% (95%CI 39.18, 45.25). Fertility desire is significantly associated with sex: being female (OR = 0.71,95%CI 0.57,0.86), partners desire (OR = 16.8, 95% CI: 9.45, 29.88), not having child (OR = 5.46 95%CI 4.24, 7.040), age < 30(OR = 2.34, 95%CI 2.10, 2.60), formal education (OR = 1.31 95%CI 1.09, 1.59)). However, use of family planning, residence, and Knowledge on Prevention of Mother to Child Transmission and disclosure status didn't show association with fertility desire.

CONCLUSION

In this finding, significant people of living with HIV have a desire to have a child. The finding showed the need to strengthen fertility desire and reproductive health care needs of HIV positive peoples. Therefore, strengthening the integration of fertility related issues with HIV continuum care will play a paramount role in averting risky sexual behaviors and Prevention of Mother to Child Transmission among peoples on ART.

Pregnancy in women diagnosed with HIV on antiretroviral therapy in Ethiopia: a retrospective cohort study

Introduction

due to increasing coverage of antiretroviral therapy (ART), more women living with HIV have improved health condition which also increases their chances of getting pregnant. However, the knowledge about pregnancy among women receiving ART in resource-constrained settings, like Ethiopia, is limited. The aim was to assess factors associated with pregnancy among women living with HIV in Ethiopia.

Methods

a retrospective cohort study from 2005 through 2013 including a total of 809 women aged 15-49 years on ART was used. The study was conducted in eight hospitals and health centers in two regions of Ethiopia. The data was collected between March and June of 2014 from patients´ pre-ART and ART registers by trained nurses, assisted by data entry clerks and supervised by senior physicians. Kaplan-Meier survival analysis and Cox regression analysis were used to examine the probability of becoming pregnant. Factors associated with pregnancy were presented with hazard ratios with 95% Confidence Interval (CI).

Results

a total of 809 women were included in this analysis, their median age was 27 years, 90% were urban residents and 40.6% were married. Four hundred eighty three (60.6%) were in WHO stage III at initiation of ART. The median CD4 count was 162.5 cell/μl at initiation of ART. Eighty-one women became pregnant during 3069 person-years of observation. The overall incidence of pregnancy was 26.4 pregnancies per 1000 person-years of observation. Women under the age of 24, those in less advanced disease stage, women with no education and those with college education had higher rates of pregnancy.

Conclusion

the results highlight that younger women, those in less advanced disease stage, either uneducated or highly educated ones have higher probability of becoming pregnant during HIV treatment. This suggests the need for integrating reproductive health services into HIV care services to meet the needs of women on ART.

Fertility desire concordance and contraceptive use among couples living with HIV in northern Nigeria

OBJECTIVES

We aimed to determine the concordance between own and perceived partner fertility intentions and identify predictors of contraceptive use among couples receiving antiretroviral therapy in Kano, Nigeria.

METHODS

A structured, validated questionnaire was used to interview 399 married men and women receiving antiretroviral therapy. Adjusted odds ratios for predictors of contraceptive use were derived from multivariate logistic regression models.

RESULTS

Most couples (68.9%) had concordant fertility intentions. Only 10.0% of couples had discordant fertility intentions. Among 232 couples (58.1%) at least one partner used contraception. Male condoms were used by 45.9% of couples (n = 183). Female methods were used by 175 couples (43.9%). Contraceptive use was significantly higher in participants who were older (≥30 years), better educated (secondary or post-secondary), had a higher monthly income (NGN ≥30,000), longer marriage duration (≥5 years), at least one living child, >1 year of antiretroviral treatment, and who were living with a serodiscordant partner and in circumstances where the decision on contraception was made by the female partner or jointly by both partners (all p < 0.05). Contraceptive use was significantly lower in participants who had not been sexually active in the last 6 months, where both partners wanted more children, and in situations lacking spousal communication about family planning (all p < 0.05).

CONCLUSION

One in 10 couples had discordant fertility intentions. Contraceptive use was suboptimal and was predicted by age, education, income, length of marriage, number of children, duration of antiretroviral therapy, partner's serostatus, sexual activity, fertility intention, spousal communication and the contraceptive decision-maker. Our findings highlight the need for spousal communication, joint contraceptive decision making and the integration of reproductive health services with antiretroviral therapy services.

Understanding the Fertility Desires and Intentions among HIV-Positive Men Living in Ontario: Survey Instrument Development and Validation

Men with HIV have highlighted the importance of understanding their fertility desires. However, most research has focused on women. We aimed (1) to develop a survey instrument to assess fertility desires and intentions among HIV-positive men and (2) to assess its face, content, and construct validity, as well as test–retest reliability and internal consistency. Principal component analysis was used for construct validity analysis in a sample of 60 men with HIV. The test–retest reliability and internal consistency were assessed using Spearman correlation and Cronbach α, respectively. The initial and the final version of the questionnaire consisted of 10 domains and 14 constructs. We found a one-component model for the 3 constructs analyzed and Cronbach α values were ≥.70. Test–retest statistic was stable with Spearman correlation >0.70. In conclusion, a reliable and valid questionnaire was developed for determining the fertility desires and intentions of men with HIV.

Health workers' knowledge of safer conception and attitudes toward reproductive rights of HIV-infected couples in Kano, Nigeria

BACKGROUND

The restriction of reproductive rights of HIV-positive couples in low-resource settings could be related to the attitudes and skills of health workers. We assessed health workers' knowledge of safer conception and their attitudes toward the reproductive rights of HIV-positive couples in a tertiary hospital in Nigeria.

METHODS

A cross-section of health workers (n=294) was interviewed using structured questionnaires. Knowledge and attitude scores were analyzed. Logistic regression was employed to generate adjusted odds ratios (AORs) for predictors of attitude.

RESULTS

Safer conception methods mentioned by respondents included timed unprotected intercourse with (27.9%) and without antiretroviral pre-exposure prophylaxis (37.4%), in vitro fertilization plus intracytoplasmic sperm injection (26.5%), and sperm washing and intrauterine insemination (24.8%). The majority (94.2%) of health workers acknowledged the reproductive rights of HIV-infected persons, although (64.6%) strongly felt that HIV-infected couples should have fewer children. Health workers reported always/nearly always counseling their patients on HIV transmission risks (64.1%) and safer conception (59.2% and 48.3% for females and males, respectively) (p<0.05). Among health workers, being older (30-39 vs <30 y) (AOR=1.33, 95% CI=1.13-2.47), married (AOR=2.15, 95% CI=1.17-5.58) and having a larger HIV-positive daily caseload (20-49 vs <20) (AOR=1.98, 95% CI=1.07-3.64) predicted positive attitude towards reproductive rights of HIV-affected couples.

CONCLUSIONS

Health workers had limited knowledge of safer conception methods, but were supportive of the reproductive rights of HIV-positive couples. Health workers in Nigeria require training to effectively counsel couples on their reproductive rights, risks and options.

Pregnancy Incidence and Fertility Desires Among Couples by HIV Status in Rakai, Uganda

BACKGROUND

The desire for more children and pregnancy rates are influenced by many relationship dynamics and HIV serostatus of couples.

SETTING

Rakai Community Cohort Study in Uganda.

METHODS

Couple data were retrospectively linked from survey rounds between 2007 and 2015 to assess drivers of fertility desire and pregnancy incidence by HIV status (M-F-; M+F+; M-F+; and M+F-). Multivariable modified Poisson regression was used to estimate prevalence ratios of fertility desire, whereas multivariable Poisson regression was used to estimate incidence rate ratios of pregnancy associated with couple characteristics.

RESULTS

Six thousand six hundred forty-seven couples contributed to 7656 person-years. Approximately 40% of couples (where at least 1 HIV+) desired more children. Unmet need for family planning was evident; couples of medium or low Socioeconomic status and with coresident children had lower fertility desires but higher pregnancy rates. Older age, being in a polygamous union, and having a HIV+ spouse in care were associated with lower fertility desire while having an older male partner was associated with higher fertility desire. Pregnancy incidence was lower with older age, among women using hormonal contraception and condoms, HIV+ concordant couples and couples where the HIV+ spouse was in care while pregnancy incidence were higher among women who desired more children, and serodiscordant couples (M-F+).

CONCLUSIONS

There are many drivers of fertility desires and pregnancy rates, and HIV does not diminish the desire for more children. Unmet need for family planning was evident and highlighted the need to understand and meet the contraceptive needs of couples.

Fertility Desire And Associated Factors Among HIV Positive Women Attending ART Clinics In Amhara Region Referral Hospitals In Northwest Ethiopia, 2017

Background

“Fertility desire” is the intention of people to have more children despite being diagnosed with HIV, whereas intentions denote a commitment to implement that desire. Despite the overwhelming effects of HIV on a fetus, there is a desire for fertility among people positive for the virus/disease worldwide.  Therefore, this study aimed to assess fertility desires and factors associated with sexually active HIV positive reproductive-age women attending ART clinics at Amhara region referral hospitals, Northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted on reproductive-age women attending the clinics at the hospitals. A total of 427 eligible women were systematically included in the study. A semi-structured questionnaire was used to collect data via interviewer-administered techniques. EpiInfo7 and STATA 14 software was used for data entry and analysis, respectively. The logistic regression analysis method was used to identify factors associated with fertility desire. Factors that had p-values of ≤0.05 were considered statistically significant.

Results

The findings indicated that 40.3% (95% CI; 35.7%, 45.0%) of the participants reported they had the desire to have children in the future. Variables such as women in the age group of 25–34 years (AOR= 2.80, 95% CI; 1.68, 4.68), participating with their sexual partner (AOR=3.52, 95% CI; 1.36, 9.13) and married women (AOR=2.32, 95% CI; 1.05, 5.10) had a positive association with the outcome variable, whereas having one or more live children (AOR=0.19, 95% CI; 0.09, 0.39) and having no formal education (AOR= 0.51, 95% CI; 0.29, 0.89) had a negative association with fertility desire.

Conclusion

The proportion of sexually active HIV-positive women with desire for children was high among women visiting referral hospitals. Therefore, programmers and policymakers need to expand new PMTCT services throughout the region and consider the effects of these factors on HIV-positive women, as they develop interventions.

Pregnancy Loss in Women with HIV is not Associated with HIV Markers: Data from a National Study in Italy, 2001-2018

Background

There is limited information on pregnancy loss in women with HIV, and it is still debated whether HIV-related markers may play a role.Objectives: To explore potential risk factors for pregnancy loss in women with HIV, with particular reference to modifiable risk factors and markers of HIV disease.

Methods

Multicenter observational study of HIV-positive pregnant women. The main outcome measure was pregnancy loss, including both miscarriage (<22 weeks) and stillbirth (≥22 weeks). Possible associations of pregnancy loss were evaluated in univariate and multivariate analyses.

Results

Among 2696 eligible pregnancies reported between 2001 and 2018, 226 (8.4%) ended in pregnancy loss (miscarriage 198, 7.3%; stillbirth 28, 1.0%). In multivariate analyses, only older age (adjusted odds ratio [AOR] per additional year of age: 1.079, 95% confidence interval [CI] 1.046-1.113), HIV diagnosis before pregnancy (AOR: 2.533, 95%CI 1.407-4.561) and history of pregnancy loss (AOR: 1.625, 95%CI 1.178-2.243) were significantly associated with pregnancy loss. No significant association with pregnancy loss was found for parity, coinfections, sexually transmitted diseases, hypertension, smoking, alcohol and substance use, CD4 cell count, HIV-RNA viral load, and CDC HIV stage.

Conclusions

Older women and those with a previous history of pregnancy loss should be considered at higher risk of pregnancy loss. The severity of HIV disease and potentially modifiable risk factors did not increase the risk of pregnancy loss.

Predictors of Safer Conception Practices Among HIV-Infected Women in Northern Nigeria

Background: Persons living with HIV often face discrimination in safe sex and reproductive choices, especially in lowresource settings. This study assessed fertility desires and intentions, risk perception and correlates of ever use of at least one safer conception method among HIV-infected women attending a tertiary health facility in Kano, Nigeria.

Methods: Structured questionnaires were administered to a cross section of 328 of 427 eligible HIV-infected women. Fertility desires and intentions, risk perception and safer conception practice were analyzed. Logistic regression was employed to assess for predictors.

Results: Of the 328 respondents, 150 respondents (45.7%) wanted more children. The proportions of respondents aware of their transmission risk during pregnancy, delivery, and breastfeeding were 69.5%, 75.3%, and 78.9%, respectively. Further, 68.9% of respondents were aware of the prospects of bearing HIV-negative children without infecting their partners. About 64.8% of women were aware of at least one safer conception method. Safer conception methods everused by the participants include: antiretroviral therapy (ART) (36.7%), timed unprotected intercourse with (10.9%), and without pre-exposure prophylaxis (PrEP) (17.2%), intravaginal insemination (7.3%) and intrauterine insemination (4.7%). Safer conception practice was predicted by marital status (married versus single, adjusted odds ratio [AOR]=1.50, 95% CI =1.10-3.55), parity (2-4 versus 0, AOR=12.1, 95% CI=3.7-39.8), occupation (civil servants versus traders, AOR=0.37, 95% CI=0.16-0.86), husband’s serostatus (seroconcordant versus serodiscordant) (AOR=1.51, 95% CI=1.13-4.64), couple contraceptive use (users versus non-users) (AOR=1.62, 95% CI=1.16-5.83) and transmission risk perception (high risk versus low/no risk) (AOR=2.14, 95% CI=1.18-3.90).

Conclusion: We found high levels of fertility desires and intentions and moderate risk perception among a cohort of HIV-infected women in urban Kano, Nigeria. The use of safer conception practices was not common. Our findings underscore the need for healthcare provider capacity building to enhance safer conception counseling and service delivery.

Prevalence and factors associated with fertility desires/intentions among individuals in HIV-serodiscordant relationships: a systematic review of empirical studies

INTRODUCTION

Better knowledge about fertility desires/intentions among HIV-serodiscordant partners who face unique challenges when considering childbearing may be helpful in the development of targeted reproductive interventions. The aim of this systematic review was to synthesize the published literature regarding the prevalence of fertility desires/intentions and its associated factors among individuals in HIV-serodiscordant relationships while distinguishing low- and middle-income countries (LMIC) from high-income countries (HIC).

METHODS

A systematic search of all papers published prior to February 2017 was conducted in four electronic databases (PubMed/MEDLINE, PsycINFO, Web of Science and Cochrane Library). Empirical studies published in peer-reviewed journals with individuals in HIV-serodiscordant relationships assessing the prevalence of fertility desires/intentions and/or the associated factors were included in this systematic review. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS AND DISCUSSION

After screening 1852 references, 29 studies were included, of which 21 were conducted in LMIC and eight in HIC. A great variability in the prevalence of fertility desires/intentions was observed in LMIC (8% to 84% (one member of the dyad included)). In HIC, the results showed a smaller discrepancy between in the prevalence (32% to 58% (one member of the dyad included)); the prevalence was higher when the couple was the unit of analysis (64% to 73%), which may be related to the fact that all these studies were conducted in the context of assisted reproduction. Few studies examined the factors associated with fertility desires/intentions, and all except one were conducted in LMIC. Individuals (e.g. number of children), couple-level (e.g. belief that the partner wanted children) and structural factors (e.g. discussions with health workers) were found to be associated.

CONCLUSIONS

The results of this systematic review suggest that many individuals in HIV-serodiscordant relationships have fertility desires/intentions, although the prevalence is particularly heterogeneous in LMIC in comparison to HIC. Well-known factors such as younger age and a fewer number of living children were consistently associated with increased fertility desires/intentions. Different couple-level factors emerged, reflecting the importance of considering both the individual and the couple. However, further studies that specifically focus on the dyad as the unit of analysis are warranted.

Reproductive needs of PLHIV in Jamaica: relationship between fertility desire, motives and depression

Background/objective: Advances in antiretroviral therapy and assisted reproduction technology which allow for longer and healthier lives and safer conception options necessitate a new understanding of the sexual and reproductive needs of persons living with HIV (PLHIV). This study examines fertility desire and motives for having children among PLHIV in Jamaica and explores the association with depressive symptoms.Methods: In a cross-sectional study, 251 PLHIV in their reproductive years voluntarily completed an interviewer-administered questionnaire. SPSS analyses involved bivariate and logistic regression models significant at p < .05.Results: A desire to have children was expressed by 66% (n = 166), mostly males and persons younger than 40 years. Of those in a current relationship (n = 126), not having previous children best predicted fertility desire (p = .001; CI 0.04-0.44) as well as motives to conceive (p = .02; CI 0.01-0.66). PLHIVs in their reproductive years who are at depression risk are those in a sero-discordant relationship (p = .01; CI 1.48-30.22) and who have been diagnosed between 1 and 4 years (p = .05; CI 0.01-1.04).Conclusions: HIV status does not dampen the desire to have future children. There is need to evaluate the sexual, reproductive and mental health needs of PLHIV.

Child Desire Among Men and Women Living with HIV/AIDS in the Traditional Culture of Vietnam

In various settings, heterogeneity in fertility rates among HIV-affected couples highlights the importance of understanding contextual factors to inform program planning and implementation. We interviewed 1016 patients with HIV/AIDS at seven clinics in Vietnam to assess their desire to have a(nother) child and willingness to pay (WTP) for prevention of mother to child transmission (PMTCT) services. One-fifth of participants reported their desire for a(another) child and this was slightly higher among men than women. Factors associated with the desire to have a(nother) child of HIV/AIDS patients included (1) not yet have a child or a son, (2) provincial and district-level service, (3) income per capita, (4) marital status and (5) history of drug injection. The average WTP for PMTCT service was US $179 (95% CI 161-197). The study highlights the need for interventions on social, cultural barriers, improved accessibility and outcomes of counseling, and better care and treatment services for couples and child affected by HIV/AIDS.

Factors related to fertility desire among female sex workers living with HIV in the Dominican Republic

Background

Female sex workers living with HIV are at increased risk for negative health outcomes and multiple levels of stigma. However, there is limited research on female sex workers living with HIV and even less focused on reproductive health.

Methods

We analyzed data using logistic regression from a cohort of 247 female sex workers of reproductive age living with HIV in Santo Domingo, Dominican Republic to assess factors associated with fertility desire.

Results

Most participants had children (93.1%; mean: 2.8; range: 1,8) and 28.3% reported fertility desire. Bivariate regression analysis uncovered that participants who desired children were less likely to report being on antiretroviral treatment and more likely to have a detectable viral load. Multivariate regression results showed participants who desired more children were: less likely to be older, have higher levels of HIV-related internalized stigma, have a history of pregnancy loss, have fewer children and have a perception that their partner has negative feelings about pregnancy.

Conclusions

Individual and interpersonal characteristics were found to be associated with fertility desire in this study. Additional in-depth research is needed to understand how the role of stigma, partner dynamics and reproductive history as it relates to fertility desire, in order to ensure the reproductive health and wellbeing of this population.

Reproductive Desires and Considerations of HIV-Positive Men in Heterosexual Relationships in New York City

The reproductive desires of HIV-positive men have been investigated far less than those of HIV-positive women, especially in the US. This qualitative study of a sample of 94 HIV-positive men in New York City who were in a relationship with a woman of reproductive age examined their reasons for wanting a child as well as the conditions under which they would feel ready to attempt conception. Participants felt a child would make them feel normal, give meaning to their lives, or make others in their life happy. Although they reported HIV-related concerns (i.e., horizontal or vertical transmission, reinfection, or shortened life expectancy), participants mostly discussed factors unrelated to HIV (e.g., finances, housing, incarceration, substance abuse, or relationships) as deterrents to acting on their desire to having a child. When providing information on safer conception, healthcare providers should be aware of the broad desires and factors informing HIV-positive men's reproductive goals.

Fertility intentions of prenatal and postpartum HIV-positive women in primary care in Mpumalanga province, South Africa: a longitudinal study

Introduction

This study aimed to assess fertility intentions (planning to have more children in the future) and associated factors among pregnant and postpartum HIV positive women in rural South Africa.

Methods

In a longitudinal study, as part of a prevention of mother to child transmission (PMTCT) intervention trial, 699 HIV positive prenatal women, were systematically recruited and followed up at 6 months and 12 months postpartum (retention rate = 59.5%).

Results

At baseline, 32.9% of the women indicated fertility intentions and at 12 months postnatal, 120 (28.0%) reported fertility intentions. In longitudinal analyses, which included time-invariant baseline characteristics predicting fertility intention over time, not having children, having a partner with unknown/HIV-negative status, and having disclosed their HIV status to their partner, were associated with fertility intentions. In a model with time-varying covariates, decreased family planning knowledge, talking to a provider about a future pregnancy, and increased male involvement were associated with fertility intentions.

Conclusion

Results support ongoing perinatal family planning and PMTCT education.

Difficult decisions: Evaluating individual and couple-level fertility intentions and HIV acquisition among HIV serodiscordant couples in Zambia

Introduction

Attempts to conceive and pregnancy may increase HIV transmission to sex partners and infants. Our study evaluated the association between fertility intentions and HIV acquisition among Zambian HIV-serodiscordant couples.

Methods

We collected demographic, behavioral, clinical exposures, and data on fertility intentions in a cohort of HIV-serodiscordant couples in Lusaka, Zambia from 2005 to 2012. We evaluated factors associated with fertility intentions stratified by gender using multivariable logistic regression. Multivariable Cox proportional hazard models were used to evaluate the associations between fertility intentions and HIV acquisition controlling for a priori confounders and covariates that substantially (>10%) changed the effect estimates in univariate analyses.

Results

Among 1,029 serodiscordant couples, 311 agreed that they wanted children in the future (30%), 368 agreed they did not want children (36%), and 344 couples disagreed about having children (34%), with men more likely than women to want children. Women wanting child(ren) was associated with increased odds of baseline pregnancy (adjusted odds ratio [aOR] = 4.80 (95% confidence interval [CI] = 2.93, 7.85)), fewer previous pregnancies (aOR = 0.85 per additional pregnancy (95% CI = 0.78, 0.93)), and partner fertility intention (aOR = 2.89 (95% CI = 2.14, 3.91)) adjusting for woman’s age, literacy, years cohabiting and HIV status. Men wanting child(ren) was associated with younger age (aOR = 0.96 per year (95% CI = 0.93, 0.99)), fewer years cohabiting (aOR = 0.95 (95% CI = 0.92, 0.98)), number of previous partners’ pregnancies (aOR = 0.90 (95% CI = 0.82, 0.98)), and partner fertility intention (aOR = 3.00 (95% CI = 2.21, 4.07)) adjusting for partner’s age, literacy, HIV status and partner’s baseline pregnancy. In adjusted survival analyses, HIV-negative women were more likely to seroconvert if they themselves wanted children (aHR = 2.36 (95% CI = 1.41, 3.96)) vs. did not want children, or if their partner wanted children (aHR = 2.34 (95% CI = 1.33, 4.11)) vs. did not want children, or if the couple agreed that they wanted children (aHR = 2.08 (95% CI = 1.01, 4.30)), adjusting for women’s age, women’s literacy, previous pregnancies and time in study. HIV-negative men were more likely to seroconvert if their female partner wanted a child in the next 12-months (aHR = 1.94 (95% CI = 1.02, 3.68)) vs. did not want children, and when both partners wanted children (aHR = 2.02 (CI = 1.09, 3.73)) vs. they did not want children, adjusting for men’s age and literacy, couple income, number of live children, male circumcision status and time in study.

Conclusion

Women had increased risk of HIV acquisition if they and/or their partner wanted a child, while men had increased risk of HIV acquisition when their partner or if both partners agreed that they wanted children. Safer-conception interventions are needed to protect HIV uninfected women and men from HIV acquisition in HIV-serodiscordant couples who want children.

Reproductive desire among women living with HIV/AIDS in Central Brazil: Prevalence and associated factors

Background

The purpose of this study was to estimate the prevalence and examine the factors associated with reproductive desire among women living with HIV/AIDS (WLWHA) in Central Brazil.

Methods

A cross-sectional study involving 274 WLWHA, aged 18 to 49 years, was conducted with the support of treatment services and non-governmental organizations that assist people living with HIV/AIDS. Data regarding sociodemographic characteristics, substance use, sexual behavior, and reproductive variables were collected through interviews. Poisson regression with robust variance was used to analyze the factors associated with reproductive desire.

Results

The prevalence of reproductive desire was 25.9% (95.0% confidence interval [CI]: 21.1–31.4%). This outcome was associated with age < 30 years (adjusted prevalence ratio [APR]: 2.93; p < 0.001), black skin color or race (APR: 2.28; p = 0.017), partner's reproductive desire (APR: 7.55; p < 0.001), absence of children (APR: 2.13; p = 0.003), history of abortion (APR: 1.65; p = 0.045) and undetectable viral load at the time of data collection (APR: 1.92; p = 0.043).

Conclusion

The prevalence of reproductive desire among WLWHA was relatively high. It is necessary to include fertility issues as part of assistance and counseling for women in referral services to support them with their feelings, goals, and needs regarding reproductive choices.

Pregnancy planning preferences among people and couples affected by human immunodeficiency virus: Piloting a discrete choice experiment

Decision-making related to pregnancy planning is complex and human immunodeficiency virus (HIV) may further complicate the process. With increasing rates of pregnancy among individuals affected by HIV, the need to understand decision-making is imperative. The primary objectives of this pilot study were to confirm the feasibility of using discrete choice experimentation (DCE) to elicit an understanding of this process and to determine the acceptability of the choice factors that were included in two novel DCEs, while gathering a preliminary understanding of preference. The choice attributes were risk of vertical HIV transmission, risk of horizontal HIV transmission, cost, probability of conception, method of conception, and travel time. Thirteen respondents completed a DCE for serodiscordant couples in which the female partner was HIV-positive, and 12 respondents completed a DCE for seroconcordant couples. All respondents' utility for an increased chance of a successful pregnancy was positive and statistically significant. In the serodiscordant dyads, the attributes of risk of horizontal transmission, risk of vertical transmission, a 5-h travel time to clinic, and cost were significantly associated with decreased utility. In the seroconcordant dyads, only the attributes of chance of risk of vertical transmission and cost were significantly associated with decreased utility. The serodiscordant dyads preferred home insemination with a syringe and the seroconcordant couples preferred conception methods within fertility clinics, over condomless sex with timed ovulation. On average, participants were willing to pay more for greater chance of conception and less willing to pay for increased risk of transmission. Couples affected by HIV are willing to participate in a DCE and the attributes that were included all seem relevant except risk of vertical transmission. There are various real-life trade-offs that are made during pregnancy planning with HIV and better understanding of these can be useful for clinicians during preconception counseling.

Childbearing intentions among sexually active HIV-infected and HIV-uninfected female adolescents in South Africa

Women of reproductive age account for nearly half of all HIV-infected people worldwide. Childbearing intention among HIV-infected women is complicated by social and reproductive concerns related to their HIV status. We conducted a cross-sectional study of HIV-infected and HIV-uninfected sexually active South African women aged 17 to 21 in order to compare their childbearing intentions and to identify predictors of the desire to have children among women with HIV. We found the rate of childbearing intention to be similarly high among both HIV-infected and HIV-uninfected study participants (80 and 79% respectively, p=0.81). History of previous parity was found to be associated with decreased intention to have children. No difference in childbearing intention was found between HIV-infected women on anti-retroviral therapy (ART) and women not on ART. High rates of childbearing intention among HIV-infected women require integration of reproductive health services with comprehensive HIV/AIDS care in order to mitigate the risks of sexual and vertical transmission of HIV.

Should They Also Have Babies? Community Attitudes Toward Sexual and Reproductive Rights of People Living With HIV/AIDS in Nigeria

BACKGROUND

People living with HIV have the right to healthy, satisfying sex lives and to appropriate services to ensure their sexual and reproductive health, including having healthy children. The reproductive rights of people living with HIV/AIDS are, however, often met with skepticism and discrimination, despite recent advances in HIV treatment.

OBJECTIVE

To assess the attitudes of community members in Kano, Nigeria, toward the right of persons living with HIV/AIDS to have healthy sexual relationships and bear children.

METHODS

A cross-section of 399 adults was interviewed using pretested structured questionnaires. Logistic regression analysis was used to obtain adjusted estimates for predictors of agreement with the rights of persons with HIV/AIDS to bear children.

FINDINGS

A substantial proportion of respondents (28.6%) strongly agreed and agreed (10.5%) that persons with HIV/AIDS should not be allowed to marry. More than a fifth of the respondents disagreed (16.0%) and strongly disagreed (8.0%) with the rights of HIV-infected persons to bear children. Agreement with the statement "HIV-infected persons should have biological children" was independently associated with higher educational status (adjusted odds ratio: 2.26, 95% confidence interval: 1.82-6.73) and awareness of prevention of mother-to-child HIV transmission effectiveness (adjusted odds ratio: 2.53, 95% confidence interval: 1.92-5.37). Of those who agreed that HIV-infected persons should have children (n = 253), 17.8% and 26.1% strongly agreed and agreed, respectively, that persons living with HIV/AIDS should be restricted to having fewer children. Further, 11.5% and 4.8% of respondents disagreed and strongly disagreed, respectively, that infertile HIV-infected couples should receive fertility treatment.

CONCLUSIONS

People living with HIV/AIDS face discriminatory attitudes to their reproductive rights in northern Nigeria. There is a need for effective, culturally appropriate information, education, and communication approaches to improving community perceptions of sexual and reproductive rights of people living with HIV/AIDS.

Reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome

OBJECTIVE

To analyze the reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome (AIDS).

METHOD

Cross-sectional and descriptive study carried out from January to December, 2015, in the outpatient care of infectious disease unit in a hospital located in Fortaleza, Ceará. Data were collected through a form applied by interview in a private setting.

RESULTS

102 women participated in the study. Most were aware that they were serologically positive with human immunodeficiency virus (HIV) during prenatal care (96.1%) and did not intend to have more children (63.7%). Women who were less than 39 years of age, had a higher educational level, and a shorter time of antiretroviral therapy had better chances of having children (p≤0.05). Having a steady partner increased the chance of desiring to have children, while tubal ligation was higher among women that did not receive counseling on family planning. Knowledge of family planning was limited because of lack of assistance provided by health professionals.

OBJETIVO

Analisar aspectos reprodutivos e conhecimento sobre planejamento familiar de mulheres com síndrome da imunodeficiência adquirida (Aids).

MÉTODO

Estudo transversal, descritivo, realizado de janeiro a dezembro de 2015, no ambulatório de infectologia de um hospital em Fortaleza, Ceará. Os dados foram coletados por meio de formulário, aplicado por entrevista em ambiente privativo.

RESULTADOS

Participaram do estudo 102 mulheres. A maioria delas teve conhecimento da sorologia positiva para vírus da imunodeficiência humana (HIV) durante o pré-natal (96,1%), e estas não pretendiam mais ter filhos (63,7%). Mulheres com idade menor que 39 anos, maior escolaridade e menor tempo de terapia antirretroviral tiveram maiores chances de ter filhos (p≤0,05). Mulheres com idade menor que 39 anos e maior escolaridade tiveram maiores chances de ter informações corretas sobre ter filhos na vigência do HIV (p≤0,05). Ter parceiro fixo aumentou a chance de desejar ter filhos, enquanto a laqueadura tubária foi maior em mulheres que não receberam orientações sobre planejamento familiar.

CONCLUSÃO

A maioria das mulheres com Aids não pretendem mais ter filhos. O conhecimento sobre o planejamento familiar foi limitado por falta de orientações pelos profissionais de saúde.

OBJETIVO

Analizar aspectos reproductivos y el conocimiento acerca de planificación familiar de las mujeres con síndrome de inmunodeficiencia adquirida (SIDA).

MÉTODO

Estudio transversal, descriptivo realizado de enero a diciembre de 2015, en la sala de enfermedades infecciosas de un hospital de Fortaleza, Ceará. Los datos fueron recolectados a través de una entrevista semiestructurada de forma de cuestionario en un ámbito privado.

RESULTADOS

El estudio incluyó a 102 mujeres. La mayoría de ellos tenían conocimiento de ser seropositivas para el virus de la inmunodeficiencia humana (VIH) durante la atención prenatal (96,1%), y que no tenía intención de tener más hijos (63,7%). Mujeres menores de 39 años, con educación superior y terapia antirretroviral más corta eran más propensas a tener hijos (p=0,05). Mujeres con edades de menos de 39 años y más educación tenían más probabilidades de tener la información correcta acerca de tener hijos en presencia del VIH (p=0,05). Tener pareja estable aumentó la posibilidad de desear tener hijos, mientras que la ligadura de trompas fue mayor en las mujeres que no han recibido orientación sobre la planificación familiar.

CONCLUSIÓN

La mayoría de las mujeres con SIDA no tienen intención de tener hijos. El conocimiento acerca de la planificación familiar se vio limitada por la falta de orientación por los profesionales de la salud.

What is the relationship between increased access to HAART, relationship status and fertility decisions amongst HIV-positive women? A literature review and meta-analysis

AIMS AND OBJECTIVES

To investigate the relationship between fertility decisions, to have already had a child or to desire to have one in the future, and the prognostic factors; access to antiretrovirals, the time since these became widely available (year of the study); and relationship status.

BACKGROUND

There have been significant advances in the treatment of human immunodeficiency virus with the advent of antiretroviral therapy which has been used to successfully reduce the rate of mother to child transmission; leading researchers to hypothesise that human immunodeficiency virus-positive women may desire to have children more so now than in the past. However, this topic is often not discussed in healthcare consultations.

DESIGN & METHODS

A systematic search was conducted on Cumulative Index of Nursing and Allied Health Literature and Medline, using the key terms 'fertility decisions' and 'human immunodeficiency virus positive'. A meta-analysis of proportions and a meta-regression were conducted using a random-effects model and a logit transformation to normalise the data. Heterogeneity was assessed using Q, I² and R² values, and p-values were produced for each regressed variable.

RESULTS

There was no statistically significant relationship between a desire to have children in the future and any of the prognostic variables. However, there were statistically significant relationships between already having had at least one child; being on antiretroviral therapy; wanting a child in the future; and being in a cohabiting partnership or marriage.

CONCLUSION

There are no reliable prognostic variables which can be used to predict fertility intentions in human immunodeficiency virus-positive women. There is, however, a significant proportion of women who wish to have children or who have already had children and are in need of reproductive counselling from their healthcare providers.

RELEVANCE TO CLINICAL PRACTICE

A greater knowledge of factors which may influence reproductive decisions amongst human immunodeficiency virus-positive position will allow healthcare professionals to individualise the care they provide.

Determinants of fertility desire among married or cohabiting individuals in Rakai, Uganda: a cross-sectional study

BACKGROUND

Recent trends in fertility rates indicate declines in total fertility rate (TFR) in some sub-Saharan African countries. However, countries such as Uganda continue to have a persistently high TFR partly attributed to strong preferences for large family sizes. We explored the factors that influence fertility desire among married or cohabiting individuals in Rakai, a rural district in southwestern Uganda.

METHODS

This cross-sectional study of fertility desire (desire to have another child) was nested in a cluster-randomized demand-creation intervention trial for the promotion of couples' HIV counseling and testing uptake among married or cohabiting individuals that was conducted in Rakai district between March 1 and April 30, 2015. A total of 1490 married or cohabiting individuals, resident in three study regions with differing background HIV prevalence, were enrolled into the study. Data were collected on socio-demographic, behavioral and fertility-related characteristics. We used a modified Poisson regression model to generate prevalence ratio (PR) as a measure of association for factors that were independently associated with fertility desire. We adjusted for clustering at community level and used STATA version 14.0 for all analyses.

RESULTS

Overall, fertility desire was high (63.1%, n = 940); higher in men (69.9%, n = 489) than women (57.1%, n = 451). More than three-quarters (78.8%, n = 1174) had 3+ biological children while slightly more than two-thirds (68.5%, n = 1020) reported an ideal family size of 5+ children. Only 30% (n = 452) reported that they had attained their desired family size. After adjusting for potential and suspected confounders, the factors that were negatively associated with fertility desire were: age 30-39 (adjusted prevalence ratio [aPR] = 0.82, 95% CI: 0.78, 0.86) and 40+ years (aPR = 0.65, 95% CI: 0.60, 0.71); having six or more biological children (aPR = 0.88, 95% CI: 0.80, 0.97); being HIV-positive (aPR = 0.86, 95% CI: 0.78, 0.95) and ever use of any family planning methods (aPR = 0.93, 95% CI: 0.87, 0.99). Being male (aPR = 1.19, 95% CI: 1.07, 1.33); having primary education (aPR = 1.21, 95% CI: 1.01, 1.44) and having not yet attained the desired family size (aPR = 4.34, 95% CI: 3.50, 5.38) were positively associated with fertility desire.

CONCLUSION

Having not yet attained one's desired family size, being male and having primary education were positively associated with fertility desire in this population. Targeting individuals who have not yet attained their desired family size, men and less educated individuals with fertility regulation interventions may help to reduce fertility desire in this population.

Exploring the Factors Considered by People Living with HIV and Their Partners during Preconception

Data are lacking on factors that may impact conception-related decision-making among individuals living with HIV. This study's aim was to shed light on these considerations. Participants were invited to complete a survey on preconception considerations. A rank-ordered logit model was fit to estimate the relative importance of listed consideration factors; the interaction of HIV status and the factors was assessed. Fifty-nine participants living with HIV and 18 partners (11 HIV-negative participants and 7 living with HIV) were included. Risk of vertical and horizontal HIV transmission and the effect of antiretroviral therapy on the fetus were the top considerations. However, individuals living with HIV prioritized vertical transmission, whereas HIV-negative participants prioritized horizontal transmission. Other factors of importance were probability of conception, stress of trying to conceive, cost associated with fertility clinics, and stigma associated with certain conception methods. This study builds our understanding of the preconception considerations for people living with HIV.

Fertility Desires and Intentions among People Living with HIV/AIDS (PLWHA) in Southern India

INTRODUCTION

The desire of people living with HIV/AIDS (PLWHA) to have children can have significant public health implications. Combination Antiretroviral Therapy (cART) has increased the life expectancy of PLWHA as a result of which they may consider child bearing. There are hardly any studies from India addressing the fertility desires among PLWHA.

AIM

This study was done to assess the fertility desires of PLWHA in Southern India.

MATERIALS AND METHODS

It was a cross-sectional study conducted among 230 HIV-positive men and women who presented to Kasturba Medical College (KMC), Mangalore, India. Study was conducted between October 2012 and October 2014. Statistical analysis was performed using SPSS software version 11.5. Chi-square test, Fisher's exact test and student t-test was used to find out the association of various factors affecting fertility desire. A p-value of less than 0.05 was considered statistically significant.

RESULTS

The mean age of our study population was 36.3±5.5 years. The mean age of males was 37.3±6 years and for female 34.9±5 years. In our study 132 (57.4%) were males. Majority were literate 229 (99%). Majority of patients were employed 166 (72%). In our study 195 (84.7%) were on cART. Out of 230 PLWHA 39 (16.95%) were unmarried and 151(65.5%) married PLHIV were living with partners at the time of study. In our study 77 (33.5%) patients had fertility desire. Age, gender, marital status, number of children, partner's fertility desire and HIV status of partner had an association with fertility desire.

CONCLUSION

Providing universal access to cART is the main aim of national programs. It is high time that these programs focus on fertility issues of PLWHA. Reproductive rights of PLWHA need to be respected. Physicians and HIV counselors should proactively discuss and address reproductive issues of PLWHA.

Dual contraceptive method use and pregnancy intention among people living with HIV receiving HIV care at six hospitals in Thailand

BACKGROUND

Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand.

METHODS

From January 2008-March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2-3 months to promote the use of dual contraceptives and were offered family planning services.

RESULTS

A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33-43), 898 (64.7%) had a steady partner, and 737 (53.1%) were male. Among those with a steady partner, 862 (96.0%) did not intend to become pregnant; 709 (82.3%) had sex during the previous 3 months, 683 (96.3%) used at least one contraceptive method, and 202 (29.6%) used dual contraceptive methods. Of the 317 PLHIV who used a single contraceptive method at baseline, 66 (20.8%) reported using dual methods at 12 months. Participants at two tertiary care hospitals where coordinators facilitated PLHIV referral between HIV and OB/GYN clinics were more likely than participants at the other hospitals to change from single method to dual method (p ≤ 0.03).

CONCLUSION

Few PLHIV in this study intended to become pregnant; however, only one-fourth used dual contraceptive methods. Integrating an assessment of the intention to become pregnant and strengthening the PLHIV referral systems in family planning services may contribute to higher rates of dual contraceptive use.

Impact of Availability and Use of ART/PMTCT Services on Fertility Desires of Previously Pregnant Women in Rakai, Uganda: A Retrospective Cohort Study

OBJECTIVE

To assess fertility desires by availability and use of antiretroviral therapy and prevention of mother-to-child transmission (ART/PMTCT) services in Rakai, Uganda.

DESIGN

Retrospective analyses of longitudinal data from the Rakai Community Cohort Study.

METHODS

Study participants were retrospectively identified and categorized by HIV status. Availability of ART/PMTCT services in Rakai was defined in three periods: (1) pre-ART/PMTCT (<2005), (2) ART/PMTCT rollout (2005-2006), and (3) universal ART/PMTCT (>2006); and use of ART/PMTCT was coded as yes if the woman received services. Trends in fertility desires were assessed by χ. "Modified" Poisson regression was performed using generalized linear models with a log link and Poisson family to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (CIs) of desire for another child among previously and currently pregnant women; PRRs were adjusted for demographic and behavioral factors.

RESULTS

A total of 4227 sexually active women in Rakai, including 436 HIV+ women, contributed 13,970 observations over 5 survey rounds. Fertility desires increased in the population in the ART/PMTCT rollout [adjusted (adj.) PRR: 1.08, 95% CI: 1.04 to 1.13] and the universal availability periods (adj. PRR: 1.11, 95% CI: 1.08 to 1.14) compared with pre-ART/PMTCT period. A total of 862 woman observations used ART/PMTCT services. Fertility desires were similar among ART/PMTCT service users and nonusers in cross-sectional analysis (adj. PRR: 0.84, 95% CI: 0.62 to 1.14) and 1 year after ART/PMTCT use (adj. PRR: 1.27, 95% CI: 0.83 to 1.94).

CONCLUSIONS

Availability of ART/PMTCT may increase fertility desires of previously pregnant women in Rakai, Uganda. Use of ART/PMTCT services was not correlated with fertility desires of previously or current pregnant women.

Fertility-related research needs among women at the margins

Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain under-represented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, women living with HIV, and women who use drugs. Yet characterization of the needs of these women is important, given their unique fertility-related concerns, including risks and barriers to care emanating from social stigmas and discrimination. This synthesis provides an overview of fertility-related evidence, highlighting where there are clear research gaps among marginalized women and the potential implications of these data shortfalls. Overall, research among marginalized women to date has addressed pregnancy prevention and in some cases fertility intentions, but the majority of studies have focused on post-conception pregnancy safety and the well-being of the child. However, among female sex workers specifically, data on pregnancy safety and the well-being of the child are largely unavailable. Within each marginalized group, preconception care and effectiveness of conception methods are consistently understudied. Ultimately, the absence of epidemiologic, clinical and programmatic evidence limits the availability and quality of reproductive health services for all women and prevents social action to address these gaps.

Family planning use among women living with HIV: knowing HIV positive status helps - results from a national survey

Background

Women living with HIV continues to encounter unintended pregnancies with a concomitant risk of mother-to-child transmission of HIV infection. Preventing unintended pregnancy among HIV-infected women is one of the strategies in the prevention of new HIV infections among children. The aim of this analysis was to assess the practice of family planning (FP) among HIV-infected women and the influence of women’s awareness of HIV positive status in the practice of FP.

Methods

The analysis was made in the Malawi Demographic and Health Survey (DHS) data among 489 non-pregnant, sexually active, fecund women living with HIV. Multiple logistic regression analysis was performed using SPSS software to identify the factors associated with FP use. Adjusted odds ratios (AOR) with 95 % confidence intervals were computed to assess the association of different factors with the practice of family planning.

Result

Of the 489 confirmed HIV positive women, 184 (37.6 %) reported that they knew that they were HIV positive. The number of women who reported that they were currently using FP method(s) were 251 (51.2 %). The number of women who reported unmet need for FP method(s) were 107 (21.9 %). In the multiple logistic regression analysis, women’s knowledge of HIV positive status [AOR: 2.32(1.54, 3.50)], secondary and above education [AOR: 2.36(1.16, 4.78)], presence of 3–4 alive children [AOR: 2.60(1.08, 6.28)] and more than 4 alive children [AOR: 3.03(1.18, 7.82)] were significantly associated with current use of FP.

Conclusion

Women’s knowledge of their HIV-positive status was found to be a significant predictor of their FP practice. Health managers and clinicians need to improve HIV counselling and testing coverage among women of child-bearing age and address the FP needs of HIV-infected women.

Messages on pregnancy and family planning that providers give women living with HIV in the context of a Positive Health, Dignity, and Prevention intervention in Mozambique

Background

Family planning is an important HIV prevention tool for women living with HIV (WLHIV). In Mozambique, the prevalence of HIV among women of reproductive age is 13.1% and the average fertility rate is high. However, family planning and reproductive health for WLHIV are under-addressed in Mozambique. This study explores provider descriptions of reproductive health messages in order to identify possible barriers and facilitators to successfully addressing family planning and pregnancy concerns of WLHIV.

Methods

In 2006, a Positive Health, Dignity, and Prevention program was introduced in Mozambique focused on training health care providers to work with patients to reduce their transmission risks. Providers received training on multiple components, including family planning and prevention of mother-to-child transmission (PMTCT). In-depth interviews were conducted with 31 providers who participated in the training in five rural clinics in three provinces. Data were analyzed using qualitative content analysis.

Results

Analysis showed that providers’ clinical messages on family planning, pregnancy, and PMTCT for WLHIV could be arranged along a continuum. Provider statements ranged from saying that WLHIV should not become pregnant and condoms are the only valid form of family planning for WLHIV, to suggesting that WLHIV can have safe pregnancies.

Conclusion

These data indicate that many providers continue to believe that WLHIV should not have children and this represents a challenge for integrating family planning into the care of WLHIV. Also, not offering WLHIV a full selection of family planning methods severely limits their ability to protect themselves from unintended pregnancies and to fully exercise their reproductive rights. Responding to the reproductive health needs of WLHIV is a critical component in HIV prevention and could increase the success of PMTCT programs.

Pregnancy intent among a sample of recently diagnosed HIV-positive women and men practicing unprotected sex in Cape Town, South Africa

BACKGROUND

Sexual and reproductive health (SRH) services for HIV-positive women and men often neglect their fertility desires. We examined factors associated with pregnancy intent among recently diagnosed HIV-positive women (N = 106) and men (N = 91) who reported inconsistent condom use and were enrolled in an SRH intervention conducted in public sector HIV care clinics in Cape Town.

METHODS

Participants were recruited when receiving their first CD4 results at the clinic. All reported unprotected sex in the previous 3 months. Logistic regression identified predictors of pregnancy intent for the total sample and by gender.

RESULTS

About three fifths of men and one fifth of women reported intent to conceive in the next 6 months. In the full-sample multiple regression analysis, men [adjusted odds ratio (AOR = 6.62)] and those whose main partner shared intent to conceive (AOR = 3.80) had significantly higher odds of pregnancy intent; those with more years of education (AOR = 0.81) and more biological children (AOR = 0.62) had lower odds of intending pregnancy. In gender-specific analyses, partner sharing pregnancy intent was positively associated with intent among both men (AOR = 3.53) and women (AOR = 13.24). Among men, odds were lower among those having more biological children (AOR = 0.71) and those unemployed (AOR = 0.30). Among women, relying on hormonal contraception was negatively associated with intent (AOR = 0.08), and main partner knowing her HIV status (AOR = 5.80) was positively associated with intent to conceive.

CONCLUSIONS

Findings underscore the importance of providing integrated SRH services, and we discuss implications for clinical practice and care.

Fertility desire among HIV-positive women in Tigray region, Ethiopia: implications for the provision of reproductive health and prevention of mother-to-child HIV transmission services

Background

There is growing recognition of the difficult reproductive decisions faced by HIV-positive women. Studies in both resource-constrained and developed countries have suggested that many HIV-positive women continue to desire children in spite of their understanding of the possible risks that HIV poses. This study investigates the factors associated with fertility desire among HIV-positive women in Tigray region, Ethiopia.

Methods

A cross-sectional survey was conducted among 964 HIV-positive women receiving HIV care in 12 health centers of Tigray region. In each health center, the number of study participants was allocated proportionally to the load of HIV-positive women in the chronic care clinics. A descriptive summary of the data and a logistic regression model were used to identify factors associated with fertility desire using odds ratios with a 95% confidence interval and P-value of 0.05.

Results

Four hundred and thirty nine (45.5%) of the participants reported a desire to have children in the future. Eighty six percent of the women had given birth to at least one live baby at the time of study, with the median number of live births being 2 (Inter quartile range = 1,3). Women in the age group of 15–24 years [AOR = 2.64(95% CI: 1.44, 4.83)] and 25–34 years [AOR = 2.37 (95% CI: 1.60, 2.4 3.50)] had higher fertility desire as compared to women in the age group of 35–49 years. Having no children [AOR = 25.76 (95% CI: 13.66, 48.56)], having one to two children [AOR = 5.14 (95% CI: 3.37, 7.84)] and disclosing HIV status to husband/sexual partner [AOR = 1.74 (95% CI: 1.11, 2.72)] were all independently associated with fertility desire.

Conclusions

Age, HIV disclosure status to husband/sexual partner, and relatively few live children were all found to influence HIV-positive women’s fertility desire. Programmers and policy makers should consider the effects of these factors for HIV-positive women as they develop HIV/AIDS interventions.

Incidence of pregnancy after antiretroviral therapy initiation and associated factors in 8 West African countries

INTRODUCTION

This study aimed at estimating the incidence of pregnancy after antiretroviral therapy (ART) initiation in 8 West African countries over a 10-year period.

METHODS

A retrospective analysis was conducted within the international database of the IeDEA West Africa Collaboration. All HIV-infected women aged <50 years and starting ART for their own health between 1998 and 2011 were eligible. Pregnancy after ART initiation was the main outcome and was based on clinical reporting. Poisson regression analysis accounting for country heterogeneity was computed to estimate first pregnancy incidence post-ART and to identify its associated factors. Pregnancy incidence rate ratios were adjusted on country, baseline CD4 count and clinical stage, hemoglobin, age, first ART regimen, and calendar year.

RESULTS

Overall, 29,425 HIV-infected women aged 33 years in median (interquartile range, 28-38) contributed for 84,870 women-years of follow-up to this analysis. The crude incidence of first pregnancy (2304 events) was 2.9 per 100 women-years [95% confidence interval (CI): 2.7 to 3.0], the highest rate being reported among women aged 25-29 years: 4.7 per 100 women-years; 95% CI: 4.3 to 5.1. The overall Kaplan-Meier probability of pregnancy occurrence by the fourth year on ART was 10.9% (95% CI: 10.4 to 11.4) and as high as 28.4% (95% CI: 26.3 to 30.6) among women aged 20-29 years at ART initiation.

CONCLUSIONS

The rate of pregnancy occurrence after ART initiation among HIV-infected women living in the West Africa region was high. Family planning services tailored to procreation needs should be provided to all HIV-infected women initiating ART and health consequences carefully monitored in this part of the world.

Desire for fertility among HIV-seroconcordant and -discordant couples in Lusaka, Zambia

Pregnancy rates and the desire to conceive are increasing among women living with HIV in Africa. However, attempts to conceive may increase the risk of HIV transmission or reinfection. A better understanding of factors influencing fertility desires would significantly contribute to programmes to meet the reproductive needs of women living with HIV. Using a couples-based approach, this paper explored fertility desires among HIV-seroconcordant and -discordant couples in Lusaka, Zambia. Participants were 208 heterosexual couples recruited from community health clinics and their respective catchment areas. Couples completed assessments on demographics, condom use, relationship quality and communication. Desire for children was often shared among couple members, and the strongest predictor of participants' desire for children was having a partner who wanted children. Additionally, the number of children participants had, their own reports of positive communication, and their partner's HIV serostatus influenced reproductive desires. Results support the involvement of both couple members in pre-conception counselling and pregnancy planning interventions. The inclusion of both partners may be a more effective strategy to respond to the reproductive needs of couples affected by HIV, enabling them to safeguard the health of both partners and infants.

Fertility treatment options for HIV-infected individuals

Many HIV-serodiscordant couples desire children and physician-assisted techniques can help individuals achieve pregnancy while reducing the risk of seroconversion in their seronegative partner. For HIV-seropositive males, sperm washing with intrauterine insemination (SW-IUI) was introduced in Europe in the early 1990s, while in the USA in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) has been primarily used to reduce the risk of viral transmission. When properly applied to well-selected populations, no seroconversion has been reported with either of these methods. Within the last 5 years, randomized controlled studies have demonstrated the efficacy of daily pre-exposure prophylaxis in reducing the risk of seroconversion in couples having intercourse when an HIV-seropositive male has undetectable viral loads. In both the USA and Europe, favorable reproductive outcomes have been reported for HIV-seropositive females undergoing IUI and IVF-ICSI. Herein, we review the use of various contemporary reproductive techniques available to HIV-serodiscordant couples interested in having children, including new data on cumulative clinical pregnancy rates and cumulative live-birth rates after IVF-ICSI for male serodiscordant couples. We conclude by proposing that pre-exposure prophylaxis with SW-IUI may be a safe, economical and effective alternative for achieving pregnancy in well-selected, monogamous HIV-serodiscordant couples where the male partner is seropositive.