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

Abstract

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 HAART 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 counseling and services that account for the diverse reproductive needs of these populations.

Sexual relations and childbearing decisions of HIV-discordant couples: an exploratory study in South Africa and Tanzania

“…21,[33][34][35][36] In this exploratory study, the majority of couples without children desired to have children, supporting the findings of other studies regarding the desire for children among people living with HIV. 33,[37][38][39][40][41] An Ethiopian study of 460 HIV-positive individuals reported strong associations between parity, age, marriage or current relationship, and the desire to have children. 41 A survey among 114 mutually disclosed sero-discordant couples in Kampala, Uganda found that 59% desired to have children.…”

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

“…This research provides evidence for advocacy for the integration of HIV and SRH services for PLHIV as part of primary health care services (Bekker et al, 2011;Cooper et al, 2009;Kawale et al, 2013;Mantell et al, 2009;Myer et al, 2007;Osman, 2011;Sarnquist et al, 2013;Smith and Mbakwem, 2010).…”

“…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).…”

“…The public health sector has not as yet given priority to the implementation of these guidelines. There are only limited family planning and basic reproductive services to assist PLHIV from lower socioeconomic standing to realize their reproductive desires in a safe way (Cooper et al, 2009;Mantell et al, 2009;Osman, 2011).…”

Coming of age? Women’s sexual and reproductive health after twentyone years of democracy in South Africa

“…58 The introduction of universal "test and treat" programmes from September 2016 and the possibility of providing ART pre-exposure prophylaxis (PrEP) to those at high risk of contracting HIV, such as HIV-discordant young couples wishing to have children, hold potential for reducing HIV transmission risks. Effective safer conception methods exist for PLHIV.…”