A Systematic Review of Factors Influencing Fertility Desires and Intentions Among People Living with HIV/AIDS: Implications for Policy and Service Delivery

Abstract

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/AIDS (PLHIV) 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 PLHIV 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 PLHIV.

Fertility-related research needs among women at the margins

“…Overview of fertility-related research areas for women of reproductive age. 23(45): [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] many factors aside from HIV influence decisions to terminate pregnancy, and that abortion is less common among women living with HIV in the antiretroviral era. 3,26 Further knowledge regarding post-abortion care and approaches to effectively integrate HIV and post-abortion care services should be expanded.…”

“…30,31 Historically, fertilityrelated HIV programming has focused on prevention of unintended pregnancy and PMTCT care for women once they are pregnant, with less attention given to the HIV prevention needs of women living with HIV or affected by HIV who are trying to conceive. 32 With a limited number of studies, service delivery records related to preconception care, specifically data characterizing safer conception services aiming to minimize the risk of sexual or vertical HIV transmission for HIV-affected couples trying to become pregnant, are scarce.…”

Reproductive desires of men and women living with HIV: implications for family planning counselling

“…Various studies acknowledge the desire of PLHIV to have children (Nattabi et al, 2009). Among HIV-positive women at clinics in the Eastern Cape (South Africa) 38.8% expressed a pregnancy desire and only 65.8% reported condom use (Peltzer et al, 2009).…”

“…Several studies found that the desire to have children was higher among young people, men and people with no or few children (Myer et al, 2006;Nattabi et al, 2009;Oladapo et al, 2005;Phaweni et al, 2010), people living in informal settlements and those using antiretroviral treatment (Cooper et al, 2009;Myer et al, 2007). Cultural factors were especially important in the desire to have children for PLHIV from sub-Saharan African countries (Nattabi et al, 2009).…”

“…Cultural factors were especially important in the desire to have children for PLHIV from sub-Saharan African countries (Nattabi et al, 2009). Craft et al(2007) reported that HIVpositive women who experienced high levels of personalized stigma were less likely to disclose their status to their partners and also more likely to desire having children (Oladapo et al, 2005;Phaweni et al, 2010) The sexual and reproductive desires of PLHIV are not perceived as significantly different from those who are not infected (Nebie et al, 2001).…”