Understanding high fertility desires and intentions among a sample of urban women living with HIV in the United States.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
AIDS and Behavior (Impact Factor: 3.49). 11/2009; 14(5):1106-14. DOI: 10.1007/s10461-009-9637-8
Source: PubMed

ABSTRACT To assess childbearing motivations, fertility desires and intentions, and their relationship with key factors, we conducted a cross-sectional survey among 181 HIV-infected women of reproductive age (15-44 years) receiving clinical care at two urban health clinics. Fertility desires (59%) and intentions (66% of those who desired a child) were high among this predominately African American sample of women, while the proportion with accurate knowledge of mother-to-child transmission (MTCT) was low (15%). Multivariate regression analyses identified factors significantly associated with the intention to have a child. Notably, age and parity did not remain significant in the adjusted model. The discrepancies between expressed desires and intentions for future childbearing, and the strong role of perceived partner desire for childbearing emphasize the need for universal reproductive counseling to help women living with HIV navigate their reproductive decisions and facilitate safe pregnancies and healthy children.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Increased life expectancy of HIV-positive individuals during recent years has drawn attention to their quality of life, which includes fulfilment of fertility desires. In particular, heterosexual HIV serodiscordant couples constitute a special group for whom the balance between desired pregnancy and the risk of viral transmission should be carefully considered and optimized. Although advanced assisted reproductive technologies are available, such treatments are expensive and are often unavailable. Moreover, standard viral load testing and antiretroviral therapy may not be accessible due to structural or individual barriers. To reduce the risk of HIV transmission, a lower cost alternative is timed condomless sex combined with other risk-reduction strategies. However, timed condomless sex requires specific knowledge of how to accurately predict the fertile window in a menstrual cycle. The aim of this study was to summarize inexpensive fertility awareness methods (FAMs) that predict the fertile window and may be useful for counselling HIV-positive couples on lower cost options to conceive. Methods: Original English-language research articles were identified by a detailed Medline and Embase search in July 2014. Relevant citations in the included articles were also retrieved. Results and discussion: Calendar method, basal body temperature and cervicovaginal mucus secretions are the most accessible and sensitive FAMs, although poor specificity precludes their independent use in ovulation detection. In contrast, urinary luteinizing hormone testing is highly specific but less sensitive, and more expensive. To maximize the chance of conception per cycle, the likelihood of natural conception needs to be assessed with a basic fertility evaluation of both partners and a combination of FAMs should be offered. Adherence to other risk-reduction strategies should also be advised, and timely referral to reproductive medicine specialists is necessary when sub/infertility is suspected. Conclusions: FAMs provide effective, economical and accessible options for HIV serodiscordant couples to conceive while minimizing unnecessary viral exposure. It is important for health care providers to initiate conversations about fertility desires in HIV-positive couples and to educate identified couples on safer conception strategies.
    Journal of the International AIDS Society 01/2015; 18(1):19447. DOI:10.7448/IAS.18.1.19447 · 4.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The reproductive decisions made by PLHIV and their partners have a long-term consequences for the survival and wellbeing of their families and a society at large. Evidence relating to fertility and reproductive intentions among PLHIV is rare, despite the fact that more than 80% of PLHIV are of reproductive age. The aim of the study was to determine fertility desire and associated factors among PLHIV attending ART clinic in Fitche Hospital.MethodsA facility based cross-sectional study design with both quantitative and qualitative data collection methods was employed from February21-April 20th, 2013. The study participants were selected by using simple random sampling technique. A pre- tested structured questionnaire was used to collect data. Both bivariate and multivariate logistic regressions were used to identify associated factors.ResultThe prevalence of fertility desire of PLHIV in Fitche Hospital was 133(39.1%) with 95% CI of (34.3% -44.3%). This study identified that factors found to be associated with fertility desire were: ¿ Age from 18-29y[AOR = 3.95, 95%CI: 1.69 - 9.22) and 30-39y(AOR = 3.91, 95%CI:1.90 -8.19)], marital length ¿4y[AOR = 5.49, 95%CI:2.08-14.51), within5-9y(AOR = 4.80, 95%CI:2.14-10.78) and 10-14y(AOR = 2.82, 95%CI:1.19 -6.63], had not biological living children[AOR = 11.42,95%CI:3.27-39.90) and had more than one child (AOR = 3.67,95%CI:1.27-10.62)], community pressure[AOR = 3.67, 95%CI:1.54-8.70], partner fertility[AOR = 7.18,95%CI:3.39-15.22)],durationHIVdiagnosis¿1y[AOR = 4.99,95%CI:1.91-13.09], disclosed HIV serostatus[AOR = 3.9,95%CI:1.37-11.10] and partner sero-difference [AOR = 2.05, 95% CI: 1.01- 4.15] were some of the factors significantly associated with fertility desire.Conclusion The prevalence of fertility desire of PLHIV in the study area was 39.1%. In this study:- age, marital length, biological child, partner, community pressure, duration of HIV-diagnosis, discordant HIV-test and disclosure of HIV-serostatus to partner were demonstrated to have more associations with fertility desire among PLHIV, therefore, these factors should be emphatically considered during PLHIV¿s reproductive health program development.
    BMC Pregnancy and Childbirth 11/2014; 14(1):382. DOI:10.1186/s12884-014-0382-2 · 2.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Globally, research has documented high fertility desires and intentions among HIV-positive women. Improving implementation of preconception care (PCC) for people living with HIV is critical, given estimates that the majority of HIV-positive women who want future biological children have not received reproductive counseling, largely due to a lack of provider-initiated conversations. This article offers initial recommendations and outlines key considerations for a research agenda to advance PCC implementation efforts in both high-resource and low-resource settings. We consider who should provide PCC; where it can be effectively delivered; when it should be offered; and two potential implementation models depending on available resources. We conclude with a call for PCC-specific implementation science and research translation to help people living with HIV achieve their reproductive goals.
    AIDS 10/2013; DOI:10.1097/QAD.0000000000000059 · 6.56 Impact Factor


Available from
Nov 20, 2014