HIV This Week

Nattabi B, Li J, Thompson SC, Orach CG, Earnest J. A Systematic Review of Factors Influencing Fertility Desires and Intentions Among People Living with HIV/AIDS: Implications for Policy and Service Delivery. AIDS Behav. 2009. DOI 10.1007/s10461-009-9537-y

With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision-making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among people living with HIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of people living with HIV.

Editors’ note: This interesting systematic review of studies of fertility desires and intentions reveals the importance of mixed methodologies (quantitative and qualitative) to contextualise findings and emphasises the use of theoretical frameworks relevant to cultural context to underpin study design and analyses. In most settings, people living with HIV are uncomfortable talking with health care providers about fertility issues, anticipating or experiencing biased information-giving and negative attitudes. Provision of services within a rights-based framework requires consideration of a risk-reduction approach to minimise vertical and horizontal HIV transmission through nonjudgmental care, treatment, and counselling.

Cooper D, Moodley J, Zweigenthal V, Bekker LG, Shah I, Myer L. Fertility Intentions and Reproductive Health Care Needs of People Living with HIV in Cape Town, South Africa: Implications for Integrating Reproductive Health and HIV Care Services. AIDS Behav. 2009;13:suppl1:38-46.

Tailoring sexual and reproductive health services to meet the needs of people living with the human immuno-deficiency virus (HIV) is a growing concern but there are few insights into these issues where HIV is most prevalent. This cross-sectional study investigated the fertility intentions and associated health care needs of 459 women and men, not sampled as intimate partners of each other, living with HIV in Cape Town, South Africa. An almost equal proportion of women (55%) and men (43%) living with HIV, reported not intending to have children as were open to the possibility of having children (45 and 57%, respectively). Overall, greater intentions to have children were associated with being male, having fewer children, living in an informal settlement and use of antiretroviral therapy. There were important gender differences in the determinants of future childbearing intentions, with being on antiretroviral treatment strongly associated with women’s fertility intentions. Gender differences were also apparent in participants’ key reasons for wanting children. A minority of participants had discussed their reproductive intentions and related issues with HIV health care providers. There is an urgent need for intervention models to integrate HIV care with sexual and reproduction health counselling and services that account for the diverse reproductive needs of these populations.

Editors’ note: This 2006 exploratory survey of fertility intentions among people living with HIV attending two public sector health centres in a high HIV prevalence residential area of Cape Town found that only 19% of women and 6% of men had consulted a doctor, nurse, or counsellor in HIV care about fertility intentions. Among women in HIV care, 11% had become pregnant since their HIV diagnosis, all unintentionally. Among women on antiretroviral treatment, 9% had become pregnant since starting treatment, with 30% of these pregnancies reportedly unintentional. On-site integration of sexual and reproductive health services into HIV care settings is urgently required in order to create space for discussions with women and men about their fertility intentions; to provide easy access to contraceptive measures for those who desire to postpone, prevent or discontinue pregnancies; and to provide timely antiretroviral prophylaxis to prevent mother-to-child transmission.