Fertility and HIV following universal access to ART in Rwanda: a cross-sectional analysis of Demographic and Health Survey data

Abstract

BackgroundHIV infection is linked to decreased fertility and fertility desires in sub-Saharan Africa due to biological and social factors. We investigate the relationship between HIV infection and fertility or fertility desires in the context of universal access to antiretroviral therapy introduced in 2004 in Rwanda.MethodsWe used data from 3532 and 4527 women aged 20–49 from the 2005 and 2010 Rwandan Demographic and Health Surveys (RDHS), respectively. The RDHSs included blood-tests for HIV, as well as detailed interviews about fertility, demographic and behavioral outcomes. In both years, multiple logistic regression was used to assess the association between HIV and fertility outcomes within three age categories (20–29, 30–39 and 40–49 years), controlling for confounders and compensating for the complex survey design.ResultsIn 2010, we did not find a difference in the odds of pregnancy in the last 5 years between HIV-seropositive and HIV-seronegative women after controlling for potential biological and social confounders. Controlling for the same confounders, we found that HIV-seropositive women under age 40 were less likely to desire more children compared to HIV-seronegative women (20–29 years adjusted odds ratio (AOR) = 0.31, 95% CI: 0.17, 0.58; 30–39 years AOR = 0.24, 95% CI: 0.14, 0.43), but no difference was found among women aged 40 or older. No associations between HIV and fertility or fertility desire were found in 2005.ConclusionsThese findings suggest no difference in births or current pregnancy among HIV-seropositive and HIV-seronegative women. That in 2010 HIV-seropositive women in their earlier childbearing years desired fewer children than HIV-seronegative women could suggest more women with HIV survived; and stigma, fear of transmitting HIV, or realism about living with HIV and prematurely dying from HIV may affect their desire to have children. These findings emphasize the importance of delivering appropriate information about pregnancy and childbearing to HIV-infected women, enabling women living with HIV to make informed decisions about their reproductive life.

Fertility Desire and Associated Factors among Sexually Active HIV Positive Women at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia: Institution-Based Cross-Sectional Study

“…Reproductive health issue including fertility desire among women enrolled in HIV care and treatment programs in the study area has important implications for the health of women, their partners, and their infants. This study revealed that the prevalence of fertility desire among HIV positive reproductive age women in the study area was 45% .The nding was exactly consistent with the study done in Tigray Region, Ethiopia which has reported that 45% of women living with HIV/AIDS had desire to have children in the future [20].The nding was also consistent with studies done in Rwanda (45.8%), Jimma Town, South West Ethiopia (46.8%) respectively [10,13]. On the other hand, the nding of the current study was lower than evidences from Addis Ababa, Ethiopia(54.6%) [22],Cameroon (83.3%) [12],Democratic Republic Congo(64%) [11].…”

“…Evidences from different studies indicate that HIV-positive women continue to desire more children in the future. In studies conducted in Rwanda, Cameroon, and Democratic Republic Congo, for example, the proportion of HIV-positive women who desired to have children in the future were 45.8%, 65% and 83% respectively [10][11][12] .In Ethiopia, a few studies have revealed different level of fertility desire among women living with HIV.Studies in Addis Ababa, West Ethiopia, and Jimma, Ethiopia indicated that 40.8% ,42% and 46.8% of HIV positive women had fertility desire respectively [8,9,13].Studies in different settings have pointed out different factors which determine the fertility desire of HIV-positive women. For example, family planning use in HIV positive women was found to be signi cantly associated with fertility desire [6,13,14].An increased fertility desire is found to be associated with absence of living children in several studies across the world [5,6,[14][15][16][17].…”

Determinants of Fertility Desire among Women Living with HIV in the Childbearing Age Attending Antiretroviral Therapy Clinic at Jimma University Medical Center, Southwest Ethiopia: A Facility-Based Case-Control Study

“…Studies revealed that age [7,10,[12][13][14][15][16][17][18][19][20], ethnicity [7,10,13], education status [9,15,18,21], religion [19,21], residence [7], marital status [10,[20][21][22], wealth status [18], abortion [13], children [12,13,20], parity [7,8,12,20,23], sexual violence [24], sexual activity [24], child HIV status [10], sexual partner [19,23], partner desire [9,13,15,17,25], discussion [10], family planning [8,21], family influence [20], CD4 count [10,…”

Fertility desire and associated factors among ART user reproductive-age women in public health facility in Gondar city administration Northwest Ethiopia

“…The availability of ART service in the country and effective prevention of mother to child transmission makes fertility desire a great reproductive health issue for persons living with HIV/AIDS [9,11]. Moreover, reproductive-age women living with HIV/ADS and their health improved due to ART service use have more fertility desire [12] The direct relationship between fertility and HIV/AIDS makes HIV preventive strategies challenge against the HIV epidemic in Ethiopia [11], Despite the risks and challenges; studies elsewhere revealed that HIV positive women continue to desire children, after knowing their HIV-positive status [13,14].In some settings, there is no difference in the proportion of pregnancy between HIV positive and HIV negative reproductive age women [15], and ART use increase fertility desire among HIV positive reproductive age women [14]. In Ethiopia irrespective of sero-status, the total fertility rate (TFR) is 4.6 children per woman with fertility peaks at age 25-29 (214 births per 1,000 women) [11].…”