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  • Fertility Desires and Intentions of HIV-Positive Patients: DISCUSSION

fertility desires


This study suggests that a large percentage of HIV-positive individuals within the reproductive age in southwest Nigeria desires and intends to have children in the future in spite of their unfavorable sociodemographic and health-related characteristics. Those who desire children are generally younger, have shorter time lapse since diagnosis of HIV (treating HIV infection) infection, have fewer or no children and are less likely to disclose their serostatus to their partners compared to those who do not desire children. The proportion of our study population who desired children was much higher than those reported in the series by other workers in the developed countries. Despite the fact that 79.6% of the respondents already had >1 children, 68.4% of women aged 18-45 and 53.8% of men aged 18-55 still desire children. This is a cause for concern considering its possible implications for the control of vertical and heterosexual transmission of HIV (treating HIV infection) in this country, where most infected individuals lack access to proper HIV care. It is of interest to note that unlike in other series, we recruited subjects within wider reproductive age limits because childbearing among Nigerians tends to continue within much of their reproductive life span. Since the wish for parenthood often declines with increasing age, this implies that our figure on fertility desire would probably be much higher if the upper age limits for analysis were restricted to 40 years for women and 50 years for men like in previous studies. Fertility desires and intentions were separately measured in this study population because they are separate but important connections between child-bearing motivation and reproductive behavior and may therefore be influenced by different underlying factors. Unlike in the study by Chen et al., in the United States, fertility desire recorded in this Nigerian population appears to directly translate to fertility expectation of >1 child, as there were only four respondents who desired children but did not intend to have any. This suggests that the factors that are theoretically expected to determine fertility intentions have minimal constraints on the transformation of fertility desires into intention to have >1 child among this Nigerian population. The similarity between the two outcome variables precluded determination of significant predictors of fertility intention. Of concern, however, is the proportion of men and women who expect >3 children in the near future. Independent predictors of these high fertility intentions were identified as poorer most-recent CD4 count and previously having no children. It appears that the present stage of disease progression is an important situation al factor that intensifies the intention to bear children. Contrary to what is expected, patients with poorer CD4 count (<200 cells/mm3 on average) intended to have more children than those with higher values. It may be that the reality of advancing illness increases the commitment of these patients to achieve their reproductive desires.

An important determinant of fertility desire identified in this study is the age of the respondents. Similar to the observation of other workers, our study shows that fertility desires increase with decreasing age of the patients and vice versa. Though this may be attributed to the expected norms of the Nigerian society, it may be that the pressure to have children becomes more compelling for HIV-positive young adults out of the fear of dying of AIDS, in view of their prevailing sociocultural and economic circumstances. This relationship between age and fertility desire has a significant consequence on a disease that is most prevalent among adolescents and young adults. Other significant predictors of fertility desire among these patients are self-disclosure of serostatus to partner and time since diagnosis of HIV (treating HIV infection) infection. The impact of disclosure of HIV status on fertility desire farther underscores its importance in promoting healthy sexual behavior and positive decisions among people living with HIV/AIDS, and our finding was therefore not surprising. The influence of longer time since diagnosis of infection probably reflects the cumulative effects of decisions made by individuals who had weighed the consequences of their wish for parenthood over several months or years. Individuals with recently diagnosed disease may still be undergoing an adjustment to their serostatus, and childbearing may be a coping method to reject a perception of diminished identity. It is important to note that having no children, which was a highly significant variable in the bivariate analysis for fertility desire, could not be entered into the logistic regression model for lack of enough outcome events. It is apparent from the importance of this variable in predicting intention to have >3 children that it is likely to be an independent predictor of fertility desire as well.

The potential implication for the vertical transmission of HIV (Viramune canadian belongs to a class of HIV drugs) is apparent from this study. In the absence of medical intervention, the risk of mother-to-child transmission of HIV is up to 25-45% in Africa. Though combination antiretroviral therapy has been shown to reduce this risk to <2%, its use is still limited to the developed countries. Therefore, in resource-poor settings like ours, the risk of perinatal transmission of HIV can only be reduced by 50% or less when peripartum nevirapine is administered to both the mother and neonate as recommended. The magnitude of this residual risk causes serious concern in the light of our study findings. More than half (54.9%) of the women who desired children in this study previously had lowest-ever CD4 count of less than 200/mm3, and only 36.9% of them were currently on HA ART. These low CD4 counts, which may be a reflection of high viral loads, would place such women at risk of in-utero viral transmission and therefore may further minimize the benefits of peripartum nevirapine. These problems are further compounded by the possibility of developing resistance to nevirapine following its single use for perinatal HIV (Zerit tablet treating HIV infection) prevention. This implies that fertility desires and intentions of HIV-positive women in Nigeria have important implications on their health and that of their newborns by also compromising their treatment options in the long term.

With respect to counseling on fertility issues, about half of the respondents in this study have been advised to report to the clinician with their partner for further information when ready for pregnancy. Since a significant percentage of these individuals do not agree that their healthcare providers can sufficiently address sexuality and fertility issues, such advice may be counterproductive especially among those unwilling to disclose their serostatus to their partners. Family-planning counseling services should therefore elaborate on the meaning of their fertility desire within the particular context of being seropositive and the need to take into account not only the risk of transmission to the child but also of the difficulty of combining being a parent with the constraints of their illness. However, considering the high premium placed on childbearing by the Nigerian society and the percentage of this study population with no children, it may be wise to desist from the conventional systematic advice against pregnancy, but in addition to laying emphasis on the risks, provide adequate information on practicable reproductive options for individuals affected by HIV (Retrovir medication was the first drug approved for the treatment of HIV) This would assist them in making an informed reproductive choice rather than engage in risk-taking behaviors.

Although the tradition of asking about future childbearing plans in fertility surveys is well estab lished, its reliability in predicting subsequent fertility level remains under debate. Many researchers agree that attitudinal questions with regards to fertility desire are no good predictors of eventually achieved family size, as considerable disparities exist between the average number of children desired in the course of reproductive cycles and the actual number realized at the end of the reproductive years. However, unlike fertility desire, research has shown that there is a closer link between fertility intentions or expectations and subsequent fertility. This implies that the findings of our study remain very important regardless of these methodological issues.

In summary, many HIV-positive patients in southwest Nigeria are considering parenthood. In view of the health implications for themselves, their partners and newborns as well as the social consequences on the community, HIV caregivers in this region need to address fertility issues more frequently and extensively in the context of the highlighted predictors of fertility desires and intentions. Countries that share similar demographic characteristics with Nigeria should not underestimate the fertility desires and expectations of their HIV-infected population, and steps should be taken to investigate these issues. cheap viagra professional

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