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Assefa S, Dheresa M, Lami M, Berhanu B, Mohammed H, Sertsu A, Negash A, Balcha T, Eyeberu A, Debella A, Getachew T, Yadeta TA. Fertility desires of antiretroviral therapy-attending HIV-positive women and its associated factors in Harari region, Ethiopia. Int Health 2024; 16:174-181. [PMID: 37128936 PMCID: PMC10911533 DOI: 10.1093/inthealth/ihad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023] Open
Abstract
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.
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Affiliation(s)
- Sirgut Assefa
- Higher clinic, P.O. box: 235, Haramaya University, Harar town, Harari, Ethiopia
| | - Merga Dheresa
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Magarsa Lami
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Bekelu Berhanu
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Hanan Mohammed
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Addisu Sertsu
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Abraham Negash
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Tegenu Balcha
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Addis Eyeberu
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Adera Debella
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Tamirat Getachew
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
| | - Tesfaye Assebe Yadeta
- Department of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar town, Harari 3200, Ethiopia
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Aderibigbe AA, Aderibigbe SA, Akande TM, Belabo D, Abiodun J, Alabi SB, Ahmed A. A Mixed Method Assessment of the Fertility Preferences of Clients Using Antiretroviral Therapy in Ilorin, Nigeria - A Descriptive Cross-sectional Survey. Niger Postgrad Med J 2024; 31:36-44. [PMID: 38321795 DOI: 10.4103/npmj.npmj_230_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome in Nigeria remains one of the highest in the world, with the country having the highest number of people living with the infection in the West African subregion. Recent estimates put the HIV prevalence rate in Nigeria at 1.9%. In the early years of the HIV epidemic, attention on the reproductive preferences of people living with HIV was not really considered because of the high risk of mortality and few options to reduce mother-to-child transmission. METHODOLOGY A descriptive cross-sectional study was carried out in November 2018 using quantitative and qualitative methods. A total of 400 participants were recruited for the quantitative part of the study and 10 respondents for each of the focus group discussion (FGD) sessions. Data were collected using an interviewer-administered questionnaire and a FGD guide. Frequencies and percentages were determined using descriptive analysis. Univariate analysis was used to explore the association between the outcome variables and the independent variables. The independent variables which showed a significant association in the univariate analysis were further subjected to multivariate analysis. RESULTS The desire to have children since their HIV diagnosis had been mooted by 255 (63.8%) respondents in the past and 64.5% of the respondents admitted to wanting to have children at some point in the future. More than half of the respondents (61%) currently wanted more children while a significant proportion of the respondents who wanted children (68.4%) wanted more than one child. CONCLUSION The study observed that the desire to have children had largely not been affected by the HIV infection as respondents still had a fairly strong desire to continue to have more children in spite of the risks of transmission involved. The study recommended that government and HIV policymakers need to ensure that HIV prevention messages and programmes adopt cultural and socio-economic considerations when designing and planning HIV prevention programmes.
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Affiliation(s)
- Adedayo Ayodele Aderibigbe
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | | | | | - Dooshima Belabo
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Joy Abiodun
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Seleem Babajide Alabi
- Kwara State Agency for the Control of HIV, Department of Programs and Research, Ilorin, Kwara State, Nigeria
| | - Abdullahi Ahmed
- Department of Community Health and Primary Healthcare, Federal Medical Centre, Abeokuta, Ogun State, Nigeria
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Eastment MC, Kinuthia J, Tapia K, Wanje G, Wilson K, Kaggiah A, Simoni JM, Mandaliya K, Poole DN, Richardson BA, Jaoko W, John-Stewart G, McClelland RS. Fertility Desire and Associations with Condomless Sex, Antiretroviral Adherence, and Transmission Potential in a Cohort of Kenyan Women Living with HIV in Sero-discordant Relationships: A Mixed Methods Study. AIDS Behav 2023:10.1007/s10461-023-04004-4. [PMID: 36759394 DOI: 10.1007/s10461-023-04004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
For women living with HIV (WLH) in serodiscordant partnerships, decisions about childbearing can challenge condom use and antiretroviral adherence. In a prospective cohort of 148 WLH in serodiscordant partnerships, 58 (39%) wanted more children in the future but were not currently trying to conceive (fertility desire), and 32 (22%) were currently trying to become pregnant (fertility intent). Detection of prostate specific antigen (PSA) in vaginal secretions, a marker for recent condomless sex, was lowest in women with fertility desire and highest in women with fertility intent. Detectable viral load followed a similar pattern. Risk of HIV transmission, when condomless sex and PSA detection occurred concurrently, was three to fourfold higher at visits with fertility intent compared to visits with fertility desire. Qualitative interviews underscored the importance women place on childbearing and suggested that they had limited information about the role of antiretroviral therapy in reducing sexual HIV transmission.
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Affiliation(s)
- McKenna C Eastment
- Department of Medicine, University of Washington, 325 9th Ave, Box 359909, Seattle, WA, 98104, USA.
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | - Kenneth Tapia
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - George Wanje
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - Katherine Wilson
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Jane M Simoni
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | | | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Walter Jaoko
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Medicine, University of Washington, 325 9th Ave, Box 359909, Seattle, WA, 98104, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - R Scott McClelland
- Department of Medicine, University of Washington, 325 9th Ave, Box 359909, Seattle, WA, 98104, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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de Souza MR, Guimarães RA, do Amaral WN, da Cunha VE, de Moura BDM, Barbosa MA, Brunini SM. Reproductive Desire in Women Living with HIV/AIDS with Serodiscordant Partners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113763. [PMID: 36360643 PMCID: PMC9655051 DOI: 10.3390/ijerph192113763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To estimate the prevalence and factors associated with reproductive desire in a sample of women living with HIV/AIDS (WLHA) with serodiscordant partners. STUDY DESIGN Between September 2015 and August 2016, a cross-sectional study was conducted among 110 WLHA from HIV/AIDS treatment services and non-governmental organizations. An interview was conducted using a structured questionnaire to collect sociodemographic data, reproductive desire, and potential predictor variables. Poisson regression was used to analyze the factors associated with reproductive desire in the sample. RESULTS The prevalence of reproductive desire was 32.7% (95% Confidence Interval: % CI: 24.7-42.0%). In regression analysis, we observed an association between reproductive desire and the following variables: age < 30 years; relationship time < 2 years; reproductive desire for the partner; and absence of children. CONCLUSIONS The prevalence of reproductive desire in the investigated sample was relatively high. Young age and reproductive desire for the partner were the main associated factors.
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Affiliation(s)
- Marise Ramos de Souza
- Curso de Enfermagem, Universidade Federal de Jataí, Jataí 75801-615, GO, Brazil
- Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
| | - Rafael Alves Guimarães
- Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
| | | | | | | | - Maria Alves Barbosa
- Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
- Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
| | - Sandra Maria Brunini
- Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
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Tilahun Wassie S, Marye Yimam S, Birhanu Fentaw T. Fertility desire of HIV-positive men and women in public health hospitals. SAGE Open Med 2022; 10:20503121221124755. [PMID: 36147871 PMCID: PMC9486265 DOI: 10.1177/20503121221124755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Despite the increased emphasis on antiretroviral therapy and other healthcare
services for HIV-infected individuals, issues of fertility desire have
received relatively little attention. In particular, little is known about
actual fertility desire and determinants of fertility desires among
HIV-infected women and men receiving antiretroviral therapy. Methods: A cross-sectional study was conducted among HIV-positive individuals in
public health hospitals of Addis Ababa City from 1 October to 30 November
2021. A pretested structured questionnaire was used to collect the data with
a consecutive sampling technique. EpiData 4.6.2 and SPSS 25 were used for
data entry and analysis. Bivariate and multivariable logistic regression
analyses were done to identify factors associated with fertility desire. An
adjusted odds ratio with a 95% confidence interval was computed for data
interpretation. A p value of ⩽0.05 was considered to be
statistically significant. Result: Among 400 participants, 55% (95% confidence interval = 50%, 60%) have future
fertility desire. Factors like age less than 35 years (adjusted odds
ratio = 24.03, 95% confidence interval = 9.99, 57.83), a secondary education
level (adjusted odds ratio = 2.78, 95% confidence interval = 1.21, 6.40),
being married (adjusted odds ratio = 2.89, 95% confidence interval = 1.39,
5.99), being employed (adjusted odds ratio = 3.12, 95% confidence interval =
1.56, 6.24), being diagnosed with HIV in the past 1 year (adjusted odds
ratio = 4.02, 95% confidence interval 2.07, 7.80) or past 2–4 years
(adjusted odds ratio = 9.80, 95% confidence interval = 3.89, 26.02) have a
significant association with future fertility desire. Respondents using
contraceptives were 90.9% less likely to have future fertility desire
(adjusted odds ratio = 0.09, 95% confidence interval = 0.05, 0.18). Conclusion: The magnitude of future fertility desire was founded high. Further research
on this topic should include qualitative studies to provide a deeper
understanding of people living with HIV fertility desires.
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Affiliation(s)
| | - Shimels Marye Yimam
- Department of Midwifery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Kownaklai J, Graham M, Hayter M. Pregnancy decision making among Thai women living with HIV: a grounded theory study: Pregnancy decision making amongst Thai women living with HIV. Midwifery 2022; 115:103490. [PMID: 36155391 DOI: 10.1016/j.midw.2022.103490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE this qualitative research study aims to understand and generate a model of the pregnancy decision-making process in Thai women living with HIV. METHOD the constructivist grounded theory of Charmaz was chosen as the research approach and method to generate a pregnancy decision-making process which is shaped and constructed by personal and social processes. DATA COLLECTION was undertaken in antenatal clinics (ANCs) at two provincial hospitals located in the Northeast of Thailand. In-depth semi-structured interviews were conducted with 15 HIV positive pregnant women. Data analysis involved open coding, making-memos and using the constant comparative method to develop a grounded theory substantive model of HIV pregnancy decision making. FINDINGS the substantive model consists of 6 categories; 1) concealing HIV positive status from partner; 2) desire to have a child; 3) becoming pregnant; 4) keeping or terminating pregnancy; 5) accepting the decision; and 6) adapting to the decision. This research finds that the main concerns women living with HIV have in deciding to have a child are balancing fear, concealing HIV status and the information that they have in each decision making step. Based on the research findings, a unique process of decision making has been found amongst these women that relates to personal and Thai social beliefs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the concept illustrates not only the process of decision making but also highlights the main stages, issues and concerns of women living with HIV wanting a child. This study recommends that health care providers need to pay more attention to counselling women and couples living with HIV by giving sufficient contraceptive information to prevent unplanned and unwanted pregnancy, to support and guide the women who want and plan for pregnancy, in advance of this happening, and helping women to deal with HIV disclosure issues related to morality and the rights of couples. Moreover, respect and support must be accorded to HIV positive women about their right to have a child if they choose to do so.
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Affiliation(s)
- Jaruwan Kownaklai
- Department of Maternal-Child Health and Midwifery, Faculty of Nursing, Mahasakham University, Thailand.
| | - Moira Graham
- Co-adviser and Lecturer in Public Health / Graduate Research Director in the School of Health and Social Work, University of Hull, UK.
| | - Mark Hayter
- Principal adviser and Head of Nursing, Manchester Metropolitan University, Manchester, UK.
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Mkwashapi D, Todd J, Mahande M, Changalucha J, Urassa M, Marston M, Renju J. No association between fertility desire and HIV infections among men and women: Findings from community-based studies before and after implementation of an early antiretroviral therapy (ART) initiation program in the rural district of North-western Tanzania. OPEN RESEARCH AFRICA 2022; 5:30. [PMID: 37600565 PMCID: PMC10432893 DOI: 10.12688/openresafrica.13432.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 08/22/2023]
Abstract
Background: Fertility is associated with the desire to have children. The impacts of HIV and antiretroviral therapy (ART) on fertility are well known, but their impacts on the desire for children are less well known in Tanzania. We used data from two studies carried out at different periods of ART coverage in rural Tanzania to explore the relationship between HIV infection and fertility desires in men and women. Methods: We conducted secondary data analysis of the two community-based studies conducted in 2012 and 2017 in the Magu Health and Demographic system site, in Tanzania. Information on fertility desires, HIV status, and social-economic and demographic variables were analyzed. Fertility desire was defined as whether or not the participant wanted to bear a child in the next two years. The main analysis used log-binomial regression to assess the association between fertility desire and HIV infection. Results: In the 2012 study, 43% (95% CI 40.7-45.3) of men and 33.3% (95% CI 31.8 - 35.0) women wanted another child in the next two years. In 2017 the percentage rose to 55.7% (95% CI 53.6 - 57.8) in men and 41.5% (95% CI 39.8 - 43.1) in women. Although fertility desire in men and women were higher in HIV uninfected compared to HIV infected, age-adjusted analysis did not show a statistical significance difference in both studies (2012: PR=1.02, 95%CI 0.835 - 1.174, p<0.915 and 2017: PR = 0.90 95%CI 0.743 - 1.084 p= 0.262). Discussion: One-third of women and forty percent of men desired for fertility in 2012, while forty percent of women and nearly half of men desired for fertility in 2017. The data showed fertility desire, in 2012 and 2017 were not related to HIV infection in both periods of ART coverage.
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Affiliation(s)
- Denna Mkwashapi
- Department of Sexual and Reproductive Health Research, Tanzania National Institute for Medical Research, Mwanza, Tanzania, Tanzania
| | - Jim Todd
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom, UK
| | - Michael Mahande
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania, Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health Research, Tanzania National Institute for Medical Research, Mwanza, Tanzania, Tanzania
| | - Mark Urassa
- Department of Sexual and Reproductive Health Research, Tanzania National Institute for Medical Research, Mwanza, Tanzania, Tanzania
| | - Milly Marston
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom, UK
| | - Jenny Renju
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania, Tanzania
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Eniyew MA, Haji Y, Abebe K, Demelash M, Mesfin Y, Embiale A, Amare B. Fertility desire and associated factors among people on antiretroviral treatment at a public health facility in Hawassa city, Southern Ethiopia. Afr Health Sci 2022; 22:24-33. [PMID: 36910367 PMCID: PMC9993251 DOI: 10.4314/ahs.v22i3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Fertility desire is the plan of people to have a child or more children in the face of being diagnosed with HIV and plan to a commitment to implement the desire. Methods An institutional-based cross-sectional study was conducted in Hawassa city public health facilities from May 09 -July 07/07/2019. Four hundred (400) study participants were selected using a simple random sampling technique. Data were collected by using interviewer-administered pre-tested structured questionnaires and chart review. The collected data were entered into EPI data version 3.1 software and then transported to SPSS version 20 for cleaning and data analysis. Bivariate and multivariate logistic regression was used to identify associated factors at p<0.05 was taken as a significant value with a 95% confidence level. Results A total of 400 clients were included in the study giving a response rate of 97 %. The overall fertility desire was 53.6 %(95%CI: 48.7%, 58.2%). Age, sexual practice in the last six months and discussing reproductive health with ART providers were significantly associated with fertility desire. Younger age was positively associated with fertility desire, age group (18-29), [Adjust odds ratio = 5.75 95%CI (2.85, 11.57)] , age group(30-39), [Adjust odds ratio= 4.71 95%CI:(2.55, 8.71)] Sexual practice in the last six months [Adjust odds ratio = 3.00 95%CI(1.46 , 6.16)] and counseling reproductive health with ART provider[Adjust odds ratio = 3.10 95%CI:(1.86,5.15)]. Conclusion The prevalence of fertility desire in this study was higher than previous studies while factors associated with fertility desire were age, sexual practice in the last six months, and discussing reproductive health with ART providers.
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Affiliation(s)
- Muche Argaw Eniyew
- Department of Midwifery, College of medicine and health sciences, Wolkite University, Wolkite, Ethiopia
| | - Yusuf Haji
- Department of Public health, College of medicine and health sciences, Hawassa University, Hawassa, Ethiopia
| | - Kelemu Abebe
- Department of Midwifery, College of medicine and health sciences, Woliata sodo University, Woliata, Ethiopia
| | - Minchil Demelash
- Department of Midwifery, College of medicine and health sciences, Wachamo University, Wachamo, Ethiopia
| | - Yibeltal Mesfin
- Department of Midwifery, College of medicine and health sciences, Wolkite University, Wolkite Ethiopia
| | - Aynamaw Embiale
- Department of Midwifery, College of medicine and health sciences, Madda Walabu University, Madda Walabu, Ethiopia
| | - Belay Amare
- Department of Midwifery, College of medicine and health sciences, Hawassa University, Hawassa, Ethiopia
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Naicker N, Yende-Zuma N, Kharsany ABM, Shozi H, Nkosi D, Naidoo A, Garrett N, Abdool Karim SS. Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa. BMC Pregnancy Childbirth 2022; 22:596. [PMID: 35883114 PMCID: PMC9317085 DOI: 10.1186/s12884-022-04829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In South Africa, women continue to face a high burden of Human Immunodeficiency Virus (HIV) infection and the possible complications thereof during pregnancy. We assessed pregnancy incidence rates and outcomes in a longitudinal HIV cohort study over a 15-year period. METHODS We evaluated pregnancies among women ≥ 18 years between 2004 and 2019 in the CAPRISA 002 study. We analysed pregnancy rates following HIV acquisition, CD4 counts and HIV viral load dynamics and pregnancy outcomes. We used linear regression to assess if the mean CD4 and log10 viral load close to delivery increases or decreases linearly across three different timepoints. RESULTS In total 245 women enrolled into the HIV negative study phase, 225 into the HIV infection phase and 232 in the antiretroviral therapy (ART) phase. Median follow-up time was 2.0 years [Interquartile Range (IQR) 0.8-2.0] during the HIV negative phase, 2.6 years; (IQR) 1.2-4.8] during HIV infection and 3.7 years (IQR 1.8-5.0) on ART, with maximum follow-up time of 2, 10 and 6 years respectively. Overall, 169 pregnancies occurred in 140 women, of which 16 pregnancies were observed during acute or early HIV infection [Incidence Rate (IR) 8.0 per 100 women-years; 95% confidence interval (CI): 4.6-12.9], 48 during established infection [IR 9.3; (CI 6.8-12.3)] and 68 on ART [IR 8.9; (CI: 7.0 - 11.4)]. Birth outcomes from 155/169 (91.7%) pregnancies were 118 (76.1%) full term live births, 17 (10.9%) premature live births, 9 (5.8%) therapeutic/elective miscarriages, 8 (5.1%) spontaneous miscarriages and 3 (1.9%) spontaneous foetal deaths or stillbirths. Six mother-to-child transmission events occurred, with four documented prior to 2008. Over time, mean CD4 count in pregnant women increased from 395 cells/µL (2004-2009) to 543 cells/µL (2010-2014) and to 696 cells/µL (2015-2019), p < 0.001. Conversely, the viral load declined from 4.2 log10 copies/ml to 2.5 log10 copies/ml and to 1.2 log10 copies/ml (p < 0.001) for the corresponding periods. CONCLUSIONS Pregnancy rates following HIV acquisition were high, emphasising a need for timeous ART provision and contraception counselling in women recently diagnosed with HIV. CD4 count and HIV viral load trajectories reflect improvements in treatment guidance for pregnant women over time.
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Affiliation(s)
- Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- School of Laboratory Medicine and Medical Science, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Hlengiwe Shozi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Duduzile Nkosi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Anushka Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, NY 10032, USA
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10
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Amaike C, Afolaranmi T, Amaike B, Agbo H, Abiodun O. Fertility desires and its predictors among persons living with HIV in a secondary health facility in Northcentral Nigeria. J Glob Infect Dis 2022; 14:106-111. [PMID: 36237570 PMCID: PMC9552346 DOI: 10.4103/jgid.jgid_6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Among people living with HIV (PLHIV), fertility desire which is the desire to have more children is increasing due to the improvement in quality of life and survival resulting from anti-retroviral treatment and also improved sexual and reproductive health services. Fertility desires can result in increased risk of HIV transmission, especially in unprotected heterosexual intercourse. There is limited information regarding the fertility desires and predictors among PLHIV in our environment. Methods: This study was aimed at assessing the fertility desires and predictors in PLHIV in Northcentral Nigeria. Study was descriptive cross-sectional. Semi-structured interviewer administered pretested questionnaires was used to get information from 170 PLHIV accessing care in a secondary health-care facility selected by the systematic sampling technique. Data were analyzed using the SPSS software version 23.0. At 95% confidence interval (CI), a P < 0.05 was considered to be statistically significant. Chi-square and logistic regression. Results: Fertility desire was found among 64.1% of the respondents. Younger age (odds ratio [OR] = 0.2270; 95% CI = 0.0662–0.7791, P = 0.0184), having no child or a smaller number of children (OR = 0.0432; CI = 0.0046–0.4050; P = 0.0059) and suppressed viral loads (OR = 4.1069; CI = 1.1650–14.4784; P = 0.0280) were the predictors for fertility desire. Conclusion: This study showed that PLHIV had high fertility desires but do not know any safe method of conception, hence intensified effort should be made by primary care providers and other health-care workers to include sexual and reproductive health counselling during routine HIV clinic visits to enable PLHIV make informed decision about their fertility desires.
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Knippler ET, Mwamba RN, Coleman JN, Knettel BA, Minja LM, Kisigo GA, Ngocho JS, Cichowitz C, Mmbaga BT, Watt MH. Attitudes Toward Pregnancy Among Women Enrolled in Prevention of Mother-to-Child Transmission of HIV (PMTCT) Services in Moshi, Tanzania. AIDS Behav 2021; 25:4008-4017. [PMID: 34125322 DOI: 10.1007/s10461-021-03339-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
For pregnant women living with HIV (WLWH), feelings about pregnancy may influence their emotional well-being and health seeking behaviors. This study examined attitudes toward pregnancy and associated factors among women enrolled in prevention of mother-to-child transmission of HIV (PMTCT) services in Moshi, Tanzania. 200 pregnant WLWH were enrolled during their second or third trimester of pregnancy and completed a structured survey. Univariable and multivariable regression models examined factors associated with attitudes toward pregnancy, including demographics, interpersonal factors, and emotional well-being. Attitudes toward the current pregnancy were generally positive, with 87% of participants reporting feeling happy about being pregnant. In the final multivariable model, having higher levels of partner support, being newly diagnosed with HIV, and having fewer children were significantly associated with more positive attitudes toward their pregnancy. Findings point to a need for tailored psychosocial support services in PMTCT, as well as comprehensive reproductive health care for WLWH.
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Affiliation(s)
- Elizabeth T Knippler
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
- UNC Gillings School of Global Public Health, 104 Rosenau Hall 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jessica N Coleman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Godfrey A Kisigo
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Cody Cichowitz
- Department of Medicine, Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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12
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Dina GD, Debelo BT, Belema D, Danusa KT, Muleta R. Fertility Desire, Knowledge of Prevention of MCT of HIV and Associated Factors Among Men and Women Attending ART Clinic at Public Health Institutions of West Shoa Zone, Oromia, Ethiopia, 2020. HIV AIDS (Auckl) 2021; 13:927-938. [PMID: 34594136 PMCID: PMC8478161 DOI: 10.2147/hiv.s328565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Globally, the human immunodeficiency virus (HIV) affects young people in their reproductive years. Most of the studies conducted in Ethiopia focus on the fertility desire of women of reproductive age and did not give due consideration to the men’s fertility perspective. Thus, this study aimed to assess the fertility desire, knowledge of prevention of mother to child of HIV (PMTCT), and associated factors among HIV-positive men and women attending ART clinic at west Shewa zone, Oromia region, Ethiopia, 2020. Methods Facility-based cross-sectional study design was applied to identify fertility desire, PMTCT knowledge, and associated factors among 590 HIV-positive reproductive age group men and women attending ART clinics at public health institutions of West Shewa zone. Data were collected by pre-tested structured questionnaires and analyzed using SPSS version 22. Binary logistic regression analysis was used to examine the association of predictors on fertility desire and knowledge about PMTCT. Odds ratio, 95% CI, and P value 0.05 were used to measure the statistical association. Results The prevalence of fertility desire and knowledge of PMTCT in the study area were 58.8% and 30.7%, respectively. The odds of fertility desire were higher among the respondents aged >25 years [AOR=4.64, 95% CI (2.75–7.85)], housewives [AOR=3.14, 95% CI (1.90–5.21)], merchants [AOR=5.31, 95% CI (2.55–11.05)], ART use for ≤5 years [AOR=5.13, 95% CI (2.37–11.12)] and among those voluntarily tested to know their HIV status [AOR=2.16, 95% CI (1.30–3.58)]. Besides, the odds of fertility desire were low among husband who cannot read and write [AOR=0.07, 95% CI (0.02–0.23)], primary education [AOR=0.22, 95% CI (0.09–0.56)], and secondary education [AOR= 0.32, 95% CI (0.14–0.73)] when compared with husband education of college and above. Likewise, the odds of PMTCT knowledge were higher among the respondents aged less than 25 years [AOR=2.53, 95% CI (1.32–4.86)] who undergone voluntary testing during HIV diagnosis reasons [AOR=1.55, 95% CI (1.03–2.35)], and ART use for more than five years [AOR=1.94, 95% CI (1.26–2.98)]. Conclusion Younger age, husband education, occupation, recent HIV test, and voluntary testing were significantly associated with fertility desire. Likewise, the younger age group, voluntary testing and counseling, and those on ART for more than five years had higher odds of PMTCT knowledge. Therefore, strengthening voluntary testing and counseling strong counseling on PMTCT throughout the follow-up care and involvement partners is of paramount importance should be insured to decrease MTCT.
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Affiliation(s)
- Gurmesa Daba Dina
- Midwifery Department, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Bikila Tefera Debelo
- Midwifery Department, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Daniel Belema
- Midwifery Department, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Kababa Temesgen Danusa
- Midwifery Department, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Rebuma Muleta
- Midwifery Department, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
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Mandell LN, Rodriguez VJ, Peltzer K, Weiss SM, Jones DL. Fertility intentions of women living with HIV and their male partners during the perinatal period in rural South Africa. Int J STD AIDS 2021; 32:740-750. [PMID: 33769899 DOI: 10.1177/0956462420987447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, 5452University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, 5452University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Psychology, University of Georgia, Athens, GA, USA
| | - Karl Peltzer
- HIV/AIDS/STIs and TB (HAST) Research Programme, 56867Human Sciences Research Council, Pretoria, South Africa.,Department of Research & Innovation, 37714University of Limpopo, Sovenga, South Africa
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, 5452University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, 5452University of Miami Miller School of Medicine, Miami, FL, USA
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Prevalence and factors associated with fertility desire among people living with HIV: A systematic review and meta-analysis. PLoS One 2021; 16:e0248872. [PMID: 33735265 PMCID: PMC7971888 DOI: 10.1371/journal.pone.0248872] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 03/07/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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15
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Health-related quality of life of people living with HIV/AIDS: the role of social inequalities and disease-related factors. Health Qual Life Outcomes 2021; 19:63. [PMID: 33632270 PMCID: PMC7905594 DOI: 10.1186/s12955-021-01702-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 02/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background Health-related quality of life (HRQoL) serves as a direct measure of individuals’ health, life expectancy and the impact that the utilization of health care has on quality of life. The purpose of this study is to assess the HRQoL of people living with HIV (PLHIV), and to ascertain its association with the social inequalities and clinical determinants among people living with HIV in Benishangul Gumuz Regional State, Ethiopia. Methods A cross-sectional study was conducted between December 2016 and February 2017; 390 people at two referral hospitals and three health centers participated in the study. The Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS Global 10) was used to measure key HRQoL domains. Global Physical Health (GPH) and Global Mental Health (GPH) summary scores were employed. GPH and GMH summary scores below 50 (the standardized mean score) were determined as poor HRQoL. Bivariate and multivariate logistic regression analyses were used to identify factors associated with GPH and GMH summary scores. Results This study included 259 (66.4%) females and 131 (33.6%) males. The GPH summary scores ranged from 16.2 to 67.7 with a mean of 48.8 (SD = 8.9). Almost 44.6% of the study population has a GPH summary score of below 50; the GMH summary scores ranged from 28.4 to 67.6 with a mean of 50.8 (SD = 8.1). About 41.8% of the study population has a GMH summary score of below 50. Unemployment, household food insecurity and comorbidities with HIV were associated with both poor GPH and poor GMH summary scores. Age below 25 years and being a member of Christian fellowship were inversely associated with poor GPH. The least wealth index score and CD4 count below 350 cells/mL were also associated with poor GMH. Conclusion Overall, socioeconomic inequalities and HIV-related clinical factors play an important role in improving the HRQoL of PLHIV. Many of these determinants are alterable risk factors. Appropriate strategies can improve the holistic management of chronic HIV care and maximize PLHIVs’ HRQoL. Such strategies require the adoption of comprehensive interventions, including policies and programmes that would improve the health, wellbeing and livelihood of PLHIV.
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16
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Akinyemi JO, Afolabi RF, Awolude OA, Afolabi Bamgboye E. Demography of remarriage and fertility desire among women receiving antiretroviral therapy in South West Nigeria. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2021; 20:15-24. [PMID: 33632069 DOI: 10.2989/16085906.2020.1853187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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 (ORadj = 3.35, CI: 1.46-7.72); polygamous family (ORadj = 2.65, CI: 1.71-4.12), and serodiscordant union (ORadj = 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 (ORadj = 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 (ORadj = 0.30, CI: 0.12-0.74) and number of surviving children (ORadj = 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.
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Affiliation(s)
- Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rotimi F Afolabi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olutosin A Awolude
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - E Afolabi Bamgboye
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Chirambira P, Madiba S, Ntuli B. Societal and individual drivers of fertility desires and intentions among people living with HIV: a cross sectional study of HIV clinic attendees in Soweto, South Africa. AIMS Public Health 2021; 9:173-184. [PMID: 35071676 PMCID: PMC8755963 DOI: 10.3934/publichealth.2022013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background High proportion of people living with HIV (PLHIV) who are in the prime of their reproductive years desire to have children. There are limited studies that explore the range of fertility intentions for PLHIV. This study investigated the fertility desires and intentions of PLHIV and the associated factors. Methods This was a cross-sectional study of 442 PLHIV receiving antiretroviral treatment (ART) in health facilities in Soweto, an urban township that is situated in the City of Johannesburg in South Africa. STATA version 13 was used to analyze the data. Results The participants' mean age was 36.3 years, 70% were females, 79.6% had at least one biological child, and 36% had 3+ children. Almost half (47%) expressed the desire for children, saying that this was because they had no biological children, or their partners wanted children, or they wanted children of a particular sex, or were feeling healthy after taking ART. An increased fertility desire was associated with absence of biological children (AOR = 5.06, 95% CI: 2.11–12.1) and with being married (AOR = 2.63, 95% CI: 1.31–5.27). A decreased fertility desire was associated with being aged 36+ (AOR = 2.63, 95% CI: 1.31–5.27), having primary education (AOR = 0.11, 95% CI: 0.01–1.30) and having ≥4 years of ART duration (AOR = 0.45, 95% CI: 0.24–0.81). Conclusion Individual factors played a significant role in shaping the fertility desires of PLHIV in this setting. The high desire for children underscore the need to integrate reproductive health services in HIV and AIDS care and treatment services and develop safer conception programmes to help PLHIV to conceive and have children safely.
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18
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Mosisa G, Tsegaye R, Wakuma B, Mulisa D, Etefa W, Abadiga M, Fekadu G, Oluma A, Turi E. Fertility desire and associated factors among people living with HIV in Ethiopia: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2020; 78:123. [PMID: 33292626 PMCID: PMC7685622 DOI: 10.1186/s13690-020-00504-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022]
Abstract
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, I2. 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.
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Affiliation(s)
- Getu Mosisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Reta Tsegaye
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Werku Etefa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Muktar Abadiga
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Oluma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Elliver M, Hallström I, Jerene D. Pregnancy in women diagnosed with HIV on antiretroviral therapy in Ethiopia: a retrospective cohort study. Pan Afr Med J 2020; 37:101. [PMID: 33425134 PMCID: PMC7757312 DOI: 10.11604/pamj.2020.37.101.23035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Degu Jerene
- Koninklijke Centrale Vereeniging (KNCV) Tuberculosis Foundation, The Hague, Netherlands
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20
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Mageda K, Mohamed M, Kulemba K. Incidence and determinants of pregnancy among women receiving HAART in Simiyu region: 14-year retrospective follow-up. TROPICAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2020. [DOI: 10.4103/tjog.tjog_92_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mekonnen B, Minyihun A. Fertility Desire And Associated Factors Among HIV Positive Women Attending ART Clinics In Amhara Region Referral Hospitals In Northwest Ethiopia, 2017. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:247-254. [PMID: 31802952 PMCID: PMC6802556 DOI: 10.2147/hiv.s221941] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/12/2019] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Bilen Mekonnen
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Minyihun
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Martins A, Alves S, Chaves C, Canavarro MC, Pereira M. Prevalence and factors associated with fertility desires/intentions among individuals in HIV-serodiscordant relationships: a systematic review of empirical studies. J Int AIDS Soc 2019; 22:e25241. [PMID: 31099170 PMCID: PMC6523008 DOI: 10.1002/jia2.25241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/16/2019] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Alexandra Martins
- Faculty of Psychology and Education SciencesUniversity of CoimbraCoimbraPortugal
| | - Stephanie Alves
- Faculty of Psychology and Education SciencesUniversity of CoimbraCoimbraPortugal
| | - Catarina Chaves
- Faculty of Psychology and Education SciencesUniversity of CoimbraCoimbraPortugal
| | - Maria C Canavarro
- Faculty of Psychology and Education SciencesUniversity of CoimbraCoimbraPortugal
| | - Marco Pereira
- Faculty of Psychology and Education SciencesUniversity of CoimbraCoimbraPortugal
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23
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Pottinger AM, Carroll K. Reproductive needs of PLHIV in Jamaica: relationship between fertility desire, motives and depression. J Reprod Infant Psychol 2019; 38:38-48. [PMID: 30939927 DOI: 10.1080/02646838.2019.1599334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Audrey M Pottinger
- Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - Kamali Carroll
- The Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston, Jamaica
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24
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Shiferaw T, Kiros G, Birhanu Z, Gebreyesus H, Berhe T, Teweldemedhin M. Fertility desire and associated factors among women on the reproductive age group of Antiretroviral treatment users in Jimma Town, South West Ethiopia. BMC Res Notes 2019; 12:158. [PMID: 30894211 PMCID: PMC6425594 DOI: 10.1186/s13104-019-4190-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/13/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives HIV remained the major cause of death in women of reproductive age worldwide. There is limited evidence regarding the fertility desire of HIV positive women receiving HIV care in the study area. Therefore, facility based cross-sectional study was conducted from March to April 2017 to assess fertility desire of HIV positive women and associated factors among mothers in receiving HIV care Jimma town, Southwest Ethiopia. Simple random sampling technique was taken to draw the sample after stratification. Data were analyzed using SPSS version 21 and statistical significance was declared at P value less than 0.05. Results This finding showed that, 175 (46.8%) of the Antiretroviral therapy users had fertility desire with those significantly associated factors; women in the age 18–29 years [AOR = 4.05, 95% CI 1.24–13.33], being married [AOR = 0.32, 95% CI (0.13–0.78)], having diploma educational level [AOR = 5.34, 95% CI 1.10, 15.60], having only boys or girls children [AOR = 2.79, 95% CI (1.24–6.25)], having 18–36$ monthly income [AOR = 1.27, 95% CI (1.56–10.67)], Partner’s HIV status [AOR = 3.56, 95% CI (3.02–9.33)] and non use of contraceptives [AOR = 2.57, 95% CI (1.08–6.13)]. Fertility desire in the study area was high. Strengthening PMTCT service should consider fertility desire of mothers living with HIV. Electronic supplementary material The online version of this article (10.1186/s13104-019-4190-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Teshome Shiferaw
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Getachew Kiros
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Science, Aksum University, P. O. Box: 298, Aksum, Ethiopia
| | - Tesfay Berhe
- Department of Public Health, College of Health Science, Aksum University, P. O. Box: 298, Aksum, Ethiopia.
| | - Mebrahtu Teweldemedhin
- Department of Medical Laboratory Sciences, College of Health Science, Aksum University, Aksum, Ethiopia
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25
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Hersey AE, Norman B, Reece R. Assessing Reproductive Decision-making Among HIV-Positive Women in Kumasi, Ghana. Int J MCH AIDS 2019; 8:54-62. [PMID: 31321146 PMCID: PMC6630488 DOI: 10.21106/ijma.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND OR OBJECTIVES HIV-positive women have higher rates of unmet need for contraception and unintended pregnancy and face unique obstacles in accessing family planning services, such as healthcare-related stigma and disclosing HIV status to partners. This study characterizes factors that influence the reproductive decision-making of women living with HIV and identifies areas for improvement in reproductive counseling in Kumasi. METHODS In this cross-sectional study, HIV-positive women, ages 18 to 45 years, presenting for care at Komfo Anokye Teaching Hospital between June and August 2017 were interviewed using structured surveys. Information gathered included demographics, method of contraceptive use, initiation of anti-retroviral therapy (ART), knowledge and use of contraception, and future reproductive plans. The primary outcome was current family planning use and future reproductive desire. Univariate analysis was used to characterize the demographics of the study group. Bivariate analysis including Chi-squared test was employed to assess the association between use of family planning between women with an HIV-positive and HIV-negative partner, with significance set at p < 0.05. RESULTS A total of 88 women were interviewed. The unmet need for contraception was 10%. Among all sexually active women, 26% did not use contraception. Fewer women with HIV-negative or untested partners were using contraception (65% and 67%, respectively), compared to women with HIV-positive partners (93%). Partner preference was the most common reason cited for not using a method of contraceptive (46%). Similar trends were found in future reproductive desires based on age cohorts, partner status, and use of family planning. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Significant barriers to family planning use among HIV-positive women remain, especially those with a serodiscordant partner. Most partners were aware of their partner's HIV status. This highlights an important opportunity to include partners in HIV and contraceptive counseling.
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Affiliation(s)
- Alicia E Hersey
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Betty Norman
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rebecca Reece
- Section of Infectious Diseases, West Virginia University, Morgantown, USA
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Pokharel R, Bhattarai G, Shrestha N, Onta S. Knowledge and utilization of family planning methods among people living with HIV in Kathmandu, Nepal. BMC Health Serv Res 2018; 18:836. [PMID: 30400972 PMCID: PMC6220510 DOI: 10.1186/s12913-018-3643-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Addressing family planning (FP) needs of people living with HIV is an effective response to HIV prevention. Healthy timing and spacing of births help ensure the health and well-being of all women and infants, regardless of their HIV-infection. In addition, preventing unintended pregnancies is an important strategy for prevention of mother to child transmission of HIV. The main purpose of this study was to explore the knowledge of family planning methods and identify factors affecting the utilization of such methods among HIV infected men and women attending two Anti-Retroviral Therapy (ART) sites of Kathmandu, Nepal. Methods This was a descriptive cross-sectional study. Two ART sites of Kathmandu were purposively chosen and a sample of 265 respondents (both men and women) was selected based on proportionate probability random sampling. A structured questionnaire was administered face to face to all of the eligible participants. Results The mean ± SD age of the participants was 36.62 ± 7.58 years. Sixty five percent of the respondents’ spouses were HIV positive. A majority of the respondents (72%) had heard of seven modern family planning methods. Considerably high number (72%) of the respondents or their spouses were using at least one of the method of family planning. The most common method was condom (83%) and the least common was IUCD (0.50%). The use of short acting (pills, depo-provera) and long acting (implant, IUCD) family planning methods other than condom dropped from 56.6 to 2% after diagnosis. Utilization of family planning methods was significantly associated with gender, education and HIV status of spouse. Males (Adjusted Odds Ratio (AOR) = 2.48, 95% CI = 1.20–5.07, p = 0.01) educated respondents (AOR = 3.27, 95% CI = 1.41–7.54, p = < 0.01) and individuals whose spouse were not infected with HIV (AOR = 4.70, 95% CI = 1.41–15.67, p = 0.01) were more likely to use FP methods. Conclusion The tendency for HIV infected men and women to avoid additional child bearing in Nepal is higher compared to sub-Saharan Africa. However, the use of effective methods of family planning is low. Therefore, more effective counselling sessions by service providers regarding the availability and use of alternative family planning methods besides condom is necessary.
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Affiliation(s)
- Rajani Pokharel
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Geeta Bhattarai
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Namuna Shrestha
- School of Public Health and Department of Community Medicine, Chitwan Medical College, Bharatpur, Nepal
| | - Sharad Onta
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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27
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Duff P, Kestler M, Chamboko P, Braschel M, Ogilvie G, Krüsi A, Montaner J, Money D, Shannon K. Realizing Women Living with HIV's Reproductive Rights in the Era of ART: The Negative Impact of Non-consensual HIV Disclosure on Pregnancy Decisions Amongst Women Living with HIV in a Canadian Setting. AIDS Behav 2018; 22:2906-2915. [PMID: 29627875 DOI: 10.1007/s10461-018-2111-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To better understand the structural drivers of women living with HIV's (WLWH's) reproductive rights and choices, this study examined the structural correlates, including non-consensual HIV disclosure, on WLWH's pregnancy decisions and describes access to preconception care. Analyses drew on data (2014-present) from SHAWNA, a longitudinal community-based cohort with WLWH across Metro-Vancouver, Canada. Multivariable logistic regression was used to model the effect of non-consensual HIV disclosure on WLWH's pregnancy decisions. Of the 218 WLWH included in our analysis, 24.8% had ever felt discouraged from becoming pregnant and 11.5% reported accessing preconception counseling. In multivariable analyses, non-consensual HIV disclosure was positively associated with feeling discouraged from wanting to become pregnant (AOR 3.76; 95% CI 1.82-7.80). Non-consensual HIV disclosure adversely affects WLWH's pregnancy decisions. Supporting the reproductive rights of WLWH will require further training among general practitioners on the reproductive health of WLWH and improved access to women-centred, trauma-informed care, including non-judgmental preconception counseling.
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Affiliation(s)
- Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- BC Women's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Mary Kestler
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- BC Women's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Patience Chamboko
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Gina Ogilvie
- BC Women's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
- Department of Obstetrics & Gynecology, University of British Columbia, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Andrea Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Julio Montaner
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Deborah Money
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- BC Women's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
- Department of Obstetrics & Gynecology, University of British Columbia, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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Siegel K, Meunier É, Tocco JU, Lekas HM. Reproductive Desires and Considerations of HIV-Positive Men in Heterosexual Relationships in New York City. AIDS Behav 2018; 22:1736-1749. [PMID: 28726042 PMCID: PMC5786488 DOI: 10.1007/s10461-017-1864-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, 9th Fl., New York, NY, 10032, USA.
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, 9th Fl., New York, NY, 10032, USA
| | - Jack Ume Tocco
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Helen-Maria Lekas
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, 9th Fl., New York, NY, 10032, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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29
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Reproduction and Fertility Beliefs, Perceptions, and Attitudes in People Living with HIV. AIDS Res Treat 2018; 2018:5349793. [PMID: 29805805 PMCID: PMC5899855 DOI: 10.1155/2018/5349793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/21/2018] [Indexed: 11/17/2022] Open
Abstract
People living with HIV (PLWH) have distinct needs when it comes to reproductive health, specifically regarding fertility, family planning, and pregnancy, and these needs are often complicated by HIV status. While there is ample research that focuses on reproductive health in PLWH through a quantitative lens, there is a lack of research using qualitative methods, namely, the narrative interview model. We searched PubMed and relevant abstracts to identify 72 articles published from 1997 to 2016 that described a qualitative framework for exploring the behaviors and perceptions regarding family planning, abortion, pregnancy, parenthood, fertility, and forced sterility in PLWH. The inclusion criteria initially showed 147 articles, which were further screened to exclude those that did not address fertility and family planning specifically. Our final sample of articles included articles related to qualitative research on reproductive attitudes, beliefs, and behaviors of PLWH. Several of these articles were mixed-methods analyses, but our focus was on the qualitative portion only. Further qualitative works in this area will not only contribute to gaps quantitative research in the field cannot capture by design, but also inform clinical practice, policy, and interventions through systematic, in-depth evaluation.
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30
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Peltzer K, Sifunda S, Mandell LN, Rodriguez VJ, Lee TK, Cook R, Weiss SM, Jones DL. Fertility intentions of prenatal and postpartum HIV-positive women in primary care in Mpumalanga province, South Africa: a longitudinal study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2018; 10:9-17. [PMID: 29497335 PMCID: PMC5818871 DOI: 10.2147/hiv.s153212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa.,Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
| | - Sibusiso Sifunda
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ryan Cook
- School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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31
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Pinsky AN, Steenbergh K, Boyd HM, Michael B, Bekele D, Kobernik E, Gebremedhin LT, Mmeje O. Healthcare provider attitudes regarding the provision of assisted reproductive services for HIV-affected couples in Addis Ababa, Ethiopia. Int J Gynaecol Obstet 2018; 141:45-51. [PMID: 29243253 DOI: 10.1002/ijgo.12426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/16/2017] [Accepted: 12/13/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the acceptability and feasibility of providing assisted reproductive services as part of routine HIV care and treatment in Ethiopia. METHODS The present cross-sectional study using semistructured in-depth interviews was conducted at St. Paul Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, during July 2014 and July 2015. The interviews assessed the perspectives of healthcare providers (HCPs) regarding the reproductive desires of HIV-affected couples, on assisting them in achieving pregnancy, and on the facilitators and barriers to offering such services as part of routine HIV care. RESULTS There were 40 HCPs from two SPHMMC clinics interviewed. All HCPs asserted that HIV-affected couples should have equal access to assisted reproductive services and most agreed that couples should have this access to reduce the risk of HIV transmission, even in the absence of underlying infertility. However, the HCPs cited systemic and structural barriers to the implementation and delivery of assisted reproductive services. CONCLUSION The integration of assisted reproductive services into HIV care and treatment programs is acceptable and feasible to HCPs. Formal training of HCPs may improve the implementation of these services for HIV-affected couples in low-resource settings.
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Affiliation(s)
- Alana N Pinsky
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Heather M Boyd
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Belen Michael
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Delayehu Bekele
- St. Paul's Hospital and Millennium Medical College, Addis Ababa, Ethiopia
| | - Emily Kobernik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Lia Tadesse Gebremedhin
- University of Michigan Medical School, Ann Arbor, MI, USA.,St. Paul's Hospital and Millennium Medical College, Addis Ababa, Ethiopia
| | - Okeoma Mmeje
- University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan School of Public Health, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Difficult decisions: Evaluating individual and couple-level fertility intentions and HIV acquisition among HIV serodiscordant couples in Zambia. PLoS One 2018; 13:e0189869. [PMID: 29364895 PMCID: PMC5783339 DOI: 10.1371/journal.pone.0189869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 12/04/2017] [Indexed: 11/19/2022] Open
Abstract
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.
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Ramos de Souza M, do Amaral WN, Alves Guimarães R, Rezza G, Brunini SM. Reproductive desire among women living with HIV/AIDS in Central Brazil: Prevalence and associated factors. PLoS One 2017; 12:e0186267. [PMID: 29053712 PMCID: PMC5650151 DOI: 10.1371/journal.pone.0186267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/28/2017] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Marise Ramos de Souza
- Nursing Course, University Federal of Goiás, Jataí, Goiás, Brazil
- Medicine School, University Federal of Goiás, Goiânia, Goiás, Brazil
| | | | - Rafael Alves Guimarães
- Tropical Diseases and Public Health, University Federal of Goiás, Goiânia, Goiás, Brazil
| | - Giovanni Rezza
- Department Infectious diseases, Istituto Superiore di Sanità, Rome, Italy
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Adilo TM, Wordofa HM. Prevalence of fertility desire and its associated factors among 15- to 49-year-old people living with HIV/AIDS in Addis Ababa, Ethiopia: a cross-sectional study design. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2017; 9:167-176. [PMID: 28919821 PMCID: PMC5587090 DOI: 10.2147/hiv.s133766] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The magnitude of unprotected sex to satisfy the desire for fertility among people living with HIV/AIDS (PLHIV) may rise more due to the availability of antiretroviral therapy (ART) in most HIV-affected countries. This could, however, have the risk of passing on HIV to sexual partners and children. The aim of this study, therefore, was to determine the magnitude and factors associated with the fertility desire of reproductive-age PLHIV in Addis Ababa, Ethiopia, for research-based and timely actions. Methods A cross-sectional study was carried out from April to June 2016 among 442 randomly selected, reproductive-age PLHIV who had been attending ART clinics in Addis Ababa. Twelve experienced and trained nurses collected the data. The questionnaire was pretested and interviewer-administered, and the interview was executed after obtaining voluntary consent from each study subject. The data were then cleaned and analyzed by using Epi Info version 3.5.4 and SPSS version 20.0, respectively. Binary logistic regression was done in order to describe the association of fertility desire with some sociodemographic and sexual behavior-related factors. Results Among the total 441 respondents, 54.6% reported the desire for fertility, 87% disclosed their HIV status, 24.3% had two or more sexual partners in the earlier year, and only 55.6% used a condom during their last sexual intercourse. In addition, current health status (AOR=2.03; 95% CI: 1.01–4.07) and partner being tested for HIV (AOR=6.31; 95% CI: 1.35–29.64) showed statistically significant associations with fertility desire during multivariate logistic regression analysis. Conclusion A considerable number of PLHIV in the study area reported a desire for having children. Current health status and partner being tested for HIV were found to be factors associated with the fertility desire among PLHIV. Thus, more efforts to effectively address the health concerns related to fertility desire and risky sexual behavior among HIV-infected people of reproductive age could play a significant role in prevention and control measures against HIV/AIDS epidemic.
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Burmen B, Obunga J, Mutai K. Disclosure status and disclosure intentions among HIV positive persons in rural western Kenya, 2011–2012. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1291096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- B. Burmen
- HIV Implementation Science and Services (HISS), Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI, CGHR), Busia Road, P.O. Box 1578-40100, Kisumu, Kenya
| | - J. Obunga
- HIV Implementation Science and Services (HISS), Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI, CGHR), Busia Road, P.O. Box 1578-40100, Kisumu, Kenya
| | - K. Mutai
- HIV Implementation Science and Services (HISS), Kenya Medical Research Institute/Centers for Global Health Research, (KEMRI, CGHR), Busia Road, P.O. Box 1578-40100, Kisumu, Kenya
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Jose H, Madi D, Chowta N, Ramapuram J, Bhaskaran U, Achappa B, Chandran V. Fertility Desires and Intentions among People Living with HIV/AIDS (PLWHA) in Southern India. J Clin Diagn Res 2016; 10:OC19-22. [PMID: 27504328 DOI: 10.7860/jcdr/2016/20282.7968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/30/2016] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Hyma Jose
- Junior Resident, Department of Medicine, Kasturba Medical College , Mangalore, Karnataka, India
| | - Deepak Madi
- Associate Professor, Department of Medicine, Kasturba Medical College, Mangalore , Karnataka, India
| | - Nithyananda Chowta
- Additional Professor, Department of Medicine, Kasturba Medical College , Mangalore, Karnataka, India
| | - John Ramapuram
- Professor, Department of Medicine, Kasturba Medical College , Mangalore, Karnataka, India
| | - Unnikrishnan Bhaskaran
- Professor, Department of Community Medicine, Kasturba Medical College , Mangalore, Karnataka, India
| | - Basavaprabhu Achappa
- Associate Professor, Department of Medicine, Kasturba Medical College , Mangalore, Karnataka, India
| | - Vishnu Chandran
- Junior Resident, Department of Medicine, Kasturba Medical College , Mangalore, Karnataka, India
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Poda A, Hema A, Konaté A, Kaboré F, Zoungrana J, Kamboulé E, Soré I, Bado G, Ouédraogo AS, Ouédraogo M, Meda N, Sawadogo AB. Pregnancy rate and birth outcomes among women receiving antiretroviral therapy in Burkina Faso: a retrospective cohort study. Pan Afr Med J 2016; 23:105. [PMID: 27222692 PMCID: PMC4867182 DOI: 10.11604/pamj.2016.23.105.7372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 02/10/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In Sub-Saharan Africa, few studies reported pregnancy incidence and outcomes in women taking antiretroviral therapy (ART). This survey aims to estimate the incidence and outcomes of pregnancy in a cohort of HIV positive women initiating ART in Bobo-Dioulasso, Burkina Faso. METHODS We carried out a retrospective cohort study. We selected women in childbearing age initiating ART and followed up in Bobo-Dioulasso teaching hospital between January 2005 and June 2011. The incidence of pregnancies during follow-up was calculated. Childbirth was defined by the expulsion of a fetus after 22 weeks of amenorrhea. Before this term, it is an abortion. Childbirth is said premature if it occurs before 37 weeks of gestation, to term if it occurs between the 38th and the 42nd week. The annual age-standardized fertility rates were calculated using the baseline population from the 2010 demographic and health survey (DHS) in Burkina Faso. RESULTS A total of 1,763 women of childbearing age under ART were included in the study. They ranged between 18 and 48 years old with a median of 35 years old. A total of 222 pregnancies were observed during 4639 women-years of follow-up, corresponding to an incidence density of 5 pregnancies for 100 women-years (95% CI: 4.2-5.5). Among the 222 pregnancies recorded, 9(4.0%) ended with abortion, 205(92.4%) with childbirth (including 15 premature childbirths); the outcome of 8(3.6%) pregnancies were unknown abortion. Live birth and stillborn rates were 94.0% (193/205) and 6.0% respectively. The standard fertility rate in our cohort was 45 live births for 1,000 women-years. The general decrease in fertility rates was 66.0% among women infected with HIV compared to the overall population. CONCLUSION This study shows a low pregnancy incidence among women initiating ART as compared to their peers from the general population. Pregnancies that occurred during ART generally end with live births. Care packages for HIV infected women of childbearing age must include reproductive health services to better address this issue.
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Affiliation(s)
- Armel Poda
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso; Institut Supérieur des Sciences de la Santé (INSSA), Université Polytechnique de Bobo Dioulasso (UPB), Bobo Dioulasso, Burkina Faso
| | - Arsène Hema
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Aina Konaté
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Firmin Kaboré
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Jacques Zoungrana
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Euloges Kamboulé
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Ibrahim Soré
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Guillaume Bado
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Abdoul-Salam Ouédraogo
- Institut Supérieur des Sciences de la Santé (INSSA), Université Polytechnique de Bobo Dioulasso (UPB), Bobo Dioulasso, Burkina Faso; Service de Bactériologie Virologie, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Macaire Ouédraogo
- Institut Supérieur des Sciences de la Santé (INSSA), Université Polytechnique de Bobo Dioulasso (UPB), Bobo Dioulasso, Burkina Faso; Service de Médecine Interne, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Nicolas Meda
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso; Centre Muraz, Bobo Dioulasso, Burkina Faso
| | - Adrien Bruno Sawadogo
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso; Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
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Reis CBDS, Araújo MAL, Andrade RFV, Miranda AEB. PREVALENCE AND FACTORS ASSOCIATED WITH PATERNITY INTENTION AMONG MEN LIVING WITH HIV/AIDS IN FORTALEZA, CEARÁ. ACTA ACUST UNITED AC 2015. [DOI: 10.1590/0104-0707201500003560014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to analyze the prevalence and factors associated with paternity intention in 162 men with HIV/AIDS in Fortaleza, Ceará. Data were collected from June to September 2012 using a questionnaire in reference outpatient centers. Pearson's chi-squared test and logistic regression model were used for analysis. In all, 41.4% of men had the intention to have children. Age <35 years (p<0.001), desire to have children before diagnosis (p<0.001), relationship for less than five years (p=0.022), partner's desire to have children (p<0.001), having no children with the partner (p=0.047), partner without children (p=0.032) and therapy for more than three years (p=0.030) presented significant statistical association with men's desire to have children. In the multivariate analysis, the desire to have children before diagnosis (p=0.004; OR:9.81; CI:1.84-52.20) and partner's desire to have children (p<0.001; OR:9.72; CI:3.48-27.12) remained statistically significant. Many men still intend to be fathers even after the HIV/AIDS diagnosis.
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