My partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda

Abstract

BackgroundThe percentages of couples in HIV sero-discordant relationships range from 5 to 31% in the various countries of Africa. Given the importance of procreation and the lack of assisted reproduction to avoid partner transmission, members of these couples are faced with a serious dilemma even after the challenge of disclosing their HIV status to their spouses. Identifying the determinants of the decision to have children among sero-discordant couples will help in setting reproductive intervention priorities in resource-poor countries.MethodsWe conducted a survey among 114 mutually disclosed sero-discordant couples (228 individuals) receiving HIV care at four centres in Greater Kampala, between June and December 2007. The data we collected was classified according to whether the man or the woman was HIV-positive. We carried out multivariate logistic regression modelling to determine factors (age, gender, and the influences of relatives and of health workers, ART knowledge, and disclosure) that are independently associated with a desire for children.ResultsThe majority, 59%, of the participants, desired to have children. The belief that their partner wanted children was a major determinant of the desire to have children, irrespective of the HIV sero-status (adjusted odds ratio 24.0 (95% CI 9.15, 105.4)). Among couples in which the woman was HIV-positive, young age and relatives' expectations for children were significantly associated with increased fertility desire, while among couples in which the man was positive; knowledge of ART effectiveness was associated with increased fertility desire. Availability of information on contraception was associated with decreased fertility desire.ConclusionsThe gender of the positive partner affects the factors associated with a desire for children. Interventions targeting sero-discordant couples should explore contraceptive choices, the cultural importance of children, and partner communication.

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.…”

“…41 A survey among 114 mutually disclosed sero-discordant couples in Kampala, Uganda found that 59% desired to have children. 37 Factors influencing fertility desire included the belief that their partner wanted children, young age, relatives' expectations and knowledge of treatment effectiveness. 37 Similar to other studies 33,39 our study shows that reproductive intentions of discordant couples are shaped by complex personal, interpersonal, medical and health care factors.…”

“…37 Factors influencing fertility desire included the belief that their partner wanted children, young age, relatives' expectations and knowledge of treatment effectiveness. 37 Similar to other studies 33,39 our study shows that reproductive intentions of discordant couples are shaped by complex personal, interpersonal, medical and health care factors. The desire and intention to have children often conflict with safer sex imperatives, preventing HIV transmission, and other HIV-related concerns.…”

The impact of highly active antiretroviral therapy on high-risk behaviour of HIV-infected patients in sub-Saharan Africa

“…HIV transmission risk in patients on HAART is low only if the following conditions are met: the HIV-infected patient is receiving HAART with excellent adherence; patients disclose their HIV status and inquire about HIV status of their sexual partners; the viral load is consistently undetectable for a long time; and no sexually transmitted infections (STIs) are present in either partners. The above conditions are not met in many sub-Saharan African settings, as many studies [56][57][58][59][60][61] report that sub-optimal adherence, high fertility intentions, and risk factors for acquisition of STI (such as multiple sexual partners, and inconsistent condom use) are common. In many settings in sub-Saharan Africa, such as eastern and southern Africa, high-risk behaviors occur in HIV patients before and after initiating HAART [62][63][64][65].…”

Effect of subsequent pregnancies on HIV disease progression among women in the Mulago Hospital MTCT-Plus program in Uganda

“…The provision of this care has led to a decrease in morbidity and mortality among HIV-positive patients [1]. It is therefore hypothesized that the improved quality of life could lead to increased fertility among HIV-positive women [2][3][4][5][6].…”