Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa.

Despite the increased emphasis on antiretroviral therapy (ART) and other health care services for HIV-infected individuals in sub-Saharan Africa, issues of fertility and childbearing have received relatively little attention. In particular, little is known about the prevalence and determinants of fertility intentions among HIV-infected women and men who are receiving ART. We conducted a cross-sectional study from August to November 2005 investigating these issues among patients attending a public sector ART service who had been receiving ART for at least one month. Overall, 311 individuals were interviewed (median age, 33 years) and 29% (n = 89) stated that they wanted to have children in the future. This proportion was slightly higher among males than females (36% versus 26%, p = 0.09). In a multivariate model predicting fertility desire among all participants, fertility desire was associated with male gender (odds ratio (OR):2.58; 95% confidence interval [CI]:1.29-5.08), younger age (OR: 0.92; 95% CI: 0.87-0.97), decreased number of children (OR: 0.32; 95% CI: 0.15-0.69), and being in a relationship of less than 5 years (OR: 3.93; 95% CI: 1.91-8.08). In addition, fertility desire was associated with increasing duration of ART among female participants, but not among males. These results suggest that a substantial proportion of HIV-infected women and men receiving ART in this setting would like to have children in the future. This highlights the importance of incorporating fertility-related counseling, as well as contraception and advice regarding safe conception and childbirth, as appropriate, into HIV treatment services. These findings also suggest that fertility desires may change through time and thus require ongoing attention as part of long-term care.

[1]  K. Peltzer,et al.  Family Planning Among HIV Positive and Negative Prevention of Mother to Child Transmission (PMTCT) Clients in a Resource Poor Setting in South Africa , 2009, AIDS and Behavior.

[2]  M. Visser,et al.  Factors affecting disclosure in South African HIV-positive pregnant women. , 2008, AIDS patient care and STDs.

[3]  L. Myer,et al.  Integrating HIV care and HIV prevention: legal, policy and programmatic recommendations. , 2008, AIDS.

[4]  M. Chesney,et al.  Prior illicit drug use and missed prenatal vitamins predict nonadherence to antiretroviral therapy in pregnancy: adherence analysis A5084. , 2008, AIDS patient care and STDs.

[5]  L. Myer,et al.  Missed opportunities to address reproductive health care needs among HIV‐infected women in antiretroviral therapy programmes , 2007, Tropical medicine & international health : TM & IH.

[6]  L. Myer,et al.  Community attitudes towards sexual activity and childbearing by HIV-positive people in South Africa , 2006, AIDS care.

[7]  L. Myer,et al.  Rapid scale-up of a community-based HIV treatment service: programme performance over 3 consecutive years in Guguletu, South Africa. , 2006, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[8]  G. Rutherford,et al.  Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda , 2006, AIDS.

[9]  L. Myer,et al.  Reproductive decisions in HIV-infected individuals , 2005, The Lancet.

[10]  J. Jelsma,et al.  An investigation into the health-related quality of life of individuals living with HIV who are receiving HAART , 2005, AIDS care.

[11]  L. Myer,et al.  Focus on Women: Linking HIV Care and Treatment with Reproductive Health Services in the MTCT-Plus Initiative , 2005, Reproductive health matters.

[12]  Dan J Stein,et al.  Determinants of unprotected sex among HIV-positive patients in South Africa , 2005, AIDS care.

[13]  J. Shelton,et al.  The imperative for family planning in ART in Africa , 2004, The Lancet.

[14]  K. Irwin,et al.  Risk behavior for transmission of human immunodeficiency virus (HIV) among HIV-seropositive individuals in an urban setting. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  C. Rietmeijer,et al.  HIV Transmission Risk Behavior and Its Relation to Antiretroviral Treatment Adherence , 2003, Sexually transmitted diseases.

[16]  A. Segurado,et al.  The Right to Love: The Desire for Parenthood among Men Living with HIV , 2003, Reproductive health matters.

[17]  F. Dabis,et al.  Sexual and reproductive life of women informed of their HIV seropositivity: a prospective cohort study in Burkina Faso. , 2001 .

[18]  F. Dabis,et al.  Incidence of pregnancies among African HIV-infected women, Abidjan, 1995-2000. , 2001, AIDS.

[19]  D. Kanouse,et al.  Fertility desires and intentions of HIV-positive men and women. , 2001, Family planning perspectives.

[20]  R. Jewkes,et al.  Risk factors for teenage pregnancy among sexually active black adolescents in Cape Town. A case control study. , 2001, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[21]  J. A. Delaney,et al.  Contraceptive use and pregnancy decision making among women with HIV. , 1999, AIDS patient care and STDs.

[22]  G. Marks,et al.  Reducing sexual transmission of HIV from those who know they are infected: the need for personal and collective responsibility. , 1999, AIDS.

[23]  T. Coates,et al.  Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling. , 1993, American journal of public health.