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


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.

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Available from: Sarah Finocchario-Kessler, Nov 20, 2014
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    • "Some others were excluded because of non-comparative nature of the studies; being qualitative by design or reviews; made a comparison of fertility desires between HIV positive and negative individuals or among sero-discordant. Finally, 20 studies (one each from Brazil, Canada and France, two from US and the rest from Africa) were eligible [7,10,20-37]. The general information on the included studies is presented in Table 1. "
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    ABSTRACT: Literature review has shown that some years back the fertility desires of people living with HIV was low but in the recent years, it was reported as increasing. However, little is known about the strength of association of fertility desire of HIV positive people with antiretroviral therapy (ART) experience, age, sex, education level, and number of children. In these meta-analyses, twenty studies from different parts of the world were included. The odds ratios of fertility desires were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for Tau2, Chi-square (Q), I2 and P-value. Sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias, respectively. The pooled analysis demonstrated that fertility desires of study participants had no association with ART. Similarly, the overall odds ratio did not show statistically significant association of fertility desires with sex and educational attainment of study participants although forest plots of some studies fall on increased and some others on decreased sides of fertility desires. The two variables that demonstrated a strong association with fertility desires were age less than 30 years and being childless. The lowest heterogeneity was found in a meta-analysis comparing ART experienced and ART naïve HIV positive people. In all meta-analyses, the sensitivity analyses showed the stability of the pooled odds ratios; and the funnel plots did not show publication or disclosure bias. Although the fertility desires among childless and younger age group was very strong, we realized that quite a significant segment of HIV-infected people have desire for fertility. Therefore, including fertility issue as integral part of HIV patient care may help several of them in their reproductive decision making (letting them know the risks and methods of prevention while anticipating pregnancy).
    Full-text · Article · Apr 2013 · BMC Public Health
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    • "Correlates of desire for ART, a measure of pregnancy intention, included younger age, ethnicity, residence in an urban region, and birth place outside of Canada. Previous publications support our findings of younger age and Black/African ethnicity as significant correlates of pregnancy intention in WLWHIV [26, 28, 29, 34, 35, 39, 43, 44]. Although African ethnicity has not been associated with desire to have children, women of African ethnicity may be more likely to intend pregnancy due to cultural factors and traditional gender roles that stress the importance of childbearing [44–47]. "
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    ABSTRACT: The purpose of this cross-sectional study is to assess the desire, need, perceptions, and knowledge of assisted reproductive technologies (ARTs) for women living with HIV (WLWHIV) and determine correlates of ART knowledge desire. WLWHIV of reproductive age were surveyed using the survey instrument "The HIV Pregnancy Planning Questionnaire" at HIV/AIDS service organizations across Ontario, Canada. Of our cohort of 500 WLWHIV, median age was 38, 88% were previously pregnant, 78% desired more information regarding ART, 59% were open to the idea of receiving ART, 39% felt they could access a sperm bank, and 17% had difficulties conceiving (self-reported). Age, African ethnicity, and residence in an urban center were correlated with desire for more ART information. Of participants, 50% wanted to speak to an obstetrician/gynecologist regarding pregnancy planning, and 74% regarded physicians as a main source of fertility service information. While the majority of participants in our cohort desire access to ART information, most do not perceive these services as readily accessible. Healthcare practitioners were viewed as main sources of information regarding fertility services and need to provide accurate information regarding access. Fertility service professionals need to be aware of the increasing demand for ART among WLWHIV.
    Full-text · Article · Aug 2012 · ISRN obstetrics and gynecology
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    • "Rarely, however, have childbearing motivations been directly compared by HIV infection status. Recent studies document fertility desires among women living with HIV in the US and globally (Cooper et al., 2009; Finocchario-Kessler et al., 2010; Loutfy et al., 2009; Nattabi, Li, Thompson , Orach, & Earnest, 2009; Stanwood, Cohn, Heiser, & Pugliese, 2007), however; they focus primarily on adult women. Few studies document pregnancy desires among HIV-infected youth. "
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    ABSTRACT: Despite a growing literature assessing pregnancy desires among HIV-infected women enrolled in clinical care, little attention has been paid to HIV-infected youth for whom pregnancy is a very relevant issue. In urban areas with high rates of teen pregnancy and HIV infection, further understanding of childbearing motivations and relationship dynamics influencing pregnancy desires among female youth is needed. This study compares the childbearing motivations, pregnancy desires, and perceived partner desire for a pregnancy among predominately African-American HIV-infected (n=46) and HIV-uninfected (n=355) female youth (15-24 years). An HIV-infected status was not significantly associated with childbearing motivations or the desire for a future pregnancy, p>0.10. HIV-infection was, however, associated with an increased likelihood to perceive that one's partner would have a positive response to a pregnancy (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.2-10.4, p=0.02) compared to uninfected peers. While race was not associated with participants' own desire for a child, white youth were significantly less likely to perceive a positive partner response to becoming pregnant than their African-American peers (aOR 0.23, 95% CI 0.09-0.56, p=0.001). These data suggest that the desire for childbearing is not diminished by HIV infection among urban female youth, highlighting the need for routine, provider-initiated discussions about childbearing with urban youth to minimized unintended pregnancies and HIV transmission.
    Full-text · Article · Jul 2011 · AIDS Care
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