HIV status and treatment influence on fertility desires among women newly becoming eligible for antiretroviral therapy in western Kenya: insights from a qualitative study

Abstract

BackgroundFactors influencing fertility desires among HIV-infected individuals remain poorly understood. With new recommendations for universal HIV treatment and increasing antiretroviral therapy (ART) access, we sought to evaluate how access to early ART influences fertility desires among HIV-infected ART-naïve women.MethodsSemi-structured in-depth interviews were conducted with a select subgroup of 20 HIV-infected ART-naïve women attending one of 13 HIV facilities in western Kenya between July and August 2014 who would soon newly become eligible to initiate ART based on the latest national policy recommendations. The interviews covered four major themes: 1) definitions of family and children’s role in community; 2) personal, interpersonal, institutional, and societal factors influencing fertility desires; 3) influence of HIV-positive status on fertility desires; and 4) influence of future ART initiation on fertility desires. An iterative process of reading transcripts, applying inductive codes, and comparing and contrasting codes was used to identify convergent and divergent themes.ResultsThe women indicated their HIV-positive status did influence—largely negatively—their fertility desires. Furthermore, initiating ART and anticipating improved health status did not necessarily translate to increased fertility desires. Instead, individual factors, such as age, parity, current health status, financial resources and number of surviving or HIV-infected children, played a crucial role in decisions about future fertility. In addition, societal influences, such as community norms and health providers’ expectations of their fertility desires, played an equally important role in determining fertility desires.ConclusionsInitiating ART may not be the leading factor influencing fertility desires among previously ART-naïve HIV-infected women. Instead, individual and societal factors appear to be the major determinants of fertility desires among these women.

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

“…Childbearing is considered to have great importance in most parts of Africa and being motherhood elevated social status [21][22][23]. In this study of 397 women of reproductive age, ART users in Gondar city administration have participated, we found that the proportion of fertility desire was 55.2%( 95%CI, 50.4, 60.2).Our finding in line with the fertility desire reported in Addis Ababa (54.6%) and…”

<p>Risky Sexual Practice and Associated Factors Among Women Living with HIV/AIDS Receiving Antiretroviral Therapy at a PMTCT Clinic in Western Oromia, Ethiopia</p>

“…Factors frequently associated with risky sexual practices were sociodemographics, fertility related, ART related and partner related conditions. 16,17,[20][21][22] Many studies show a high incidence of STI during ART treatment 14,18,[23][24][25][26] and continued fertility desire among those living with HIV, [27][28][29][30][31] both suggesting the aspiration for and practice of unprotected sex. Ethiopia is primarily focusing on people uninfected with HIV and the sexual risk practices of HIV infected individuals did not receive due attention.…”

Resumption of postpartum sexual activity and menses among HIV‐infected women on lifelong antiretroviral treatment compared to HIV‐uninfected women in Africa

“…This may also explain the persistently high fertility observed in Malawi . Studies from Uganda and Kenya also reported that early resumption of sexual activity after delivery and fertility desires were associated with social, demographic, and societal factors …”