Fertility Desires and Intentions of HIV-Positive Patients: RESULTS

Out of the 156 eligible patients seen at the clinic during the study period, 147 agreed to participate in the study, giving a response rate of 94.2%. The sociodemographic characteristics of the respondents are shown in Table 1. The percent of participants who were in their fourth decade of life was 43.5%. One-fifth of the participants previously had no children, while 39.5% of them had >3 children. Those who had no children were on average much younger than those who had children (29.4 ± 7.5 vs. 37.9 ± 8.3 years; t=5.09, p=0.0000). Respondents were mainly Christians from the Yoruba ethnic background and of low socioeconomic status. Eighty-six (58.5%) of the participants had at least secondary education. More than half of them were married or in a relationship, while over one-fifth were widowed. Recent CD4 count of <200 cells/mm³ was recorded in 28.6% of the participants, and about half of them were on HAART. Seventy-three percent of those on HAART obtained a free supply of antiretroviral drugs from the clinic, while 27.0% of them were on self-purchased drugs. Respectively, 17.1% and 39.0% of those who were married or in a relationship had primary partners who were also HIV-positive and HIV-negative, while 43.9% of them did not know their partners’ serostatus. About two-thirds of these individuals have disclosed their HIV (Retrovir medication was the first drug approved for the treatment of HIV) serostatus to their spouse or primary partner.

Table 1. Sociodemographic characteristics of study participants

Fertility Desires and Intentions

Sixty-five (68.4%) of the female and 28 (53.8%) of the male respondents expressed the desire for children, giving a total of 93 (63.3%) of all respondents (Table 2). Among those desiring children, only 4.3% did not intend to bear any children in the future. Women were significantly more likely to expect >3 children compared to men. Of those participants who had partners, 70.8% of women and 47.1% of men have partners who also desired children. Respectively, 71.5% and 93.8% of men and women who desired children intended to have >2 in the near future.

Table 2. Percentage distribution of HIV-positive men and women, by fertility desires and intentions

There was no statistically significant difference between the proportions of those who desired fertility among patients who were currently married and those who were not married (56.3% vs. 68.7%; p=0.1213), and among those who had at least a secondary education compared to those who had less-than-secondary education (69.8% vs. 54.1%; p=0.0622). Table 3 shows the distribution of study participants by selected sociodemographic and health variables, according to their desire for children. From bivariate analyses, the characteristics that were positively and significantly associated with desire for children included younger age, having no children, and better self-ratings of overall health and physical functioning. All 30 individuals who had no children desired and intended to have children, and they constituted 32.3% of all the respondents who desired childbearing (not shown). Those whose partners desired fertility were more likely to desire childbearing compared to those whose partners did not desire children (48/52 vs. 0/24; p=0.0000). Factors that were significantly associated with lowered desire for children included higher monthly income, being on HAART, longer duration of HIV (Zerit tablet treating HIV infection) clinic attendance, longer period since diagnosis of HIV infection, disclosure of serostatus to partner and better most-recent CD4 count. The results of the multivariate logistic regression analyses for the predictor variables included in the model for fertility desire are shown in Table 3.

Table 3. Percentage distribution and means values of study participants by selected characteristics, according to desire for children

The table shows that increasing age of respondents (adjusted OR: 0.83, 95% CI: 0.73-0.93) and time since diagnosis of HIV (Viramune canadian belongs to a class of HIV drugs) infection (adjusted OR: 0.96, 95% CI: 0.90-0.99) significantly reduce the odds of fertility desire, while those who disclosed their serostatus to their spouse/primary partner were less likely to desire children than those who did not disclose (adjusted OR: 0.01,95% CI: 0.00-0.17).

Table 4. Percentage distribution and means values of study participants by selected characteristics, according to expectation of children

The percentage distribution and mean values of respondents who desired children, by selected characteristics, according to expectation of 1-2 and >3 children, are shown in Table 4. Bivariate tests showed that previously having no child, poorer most-recent CD4 count and emotional well-being were significantly associated with expectation of >3 children as against 1-2 children. Those who intended to bear >3 children were more likely to be sad or calm and peaceful in the previous one month compared to those who intended to have 1-2 children. Partner’s desire was not significantly associated with intention to bear >3 children as against 1-2 (p=0.2845). Having controlled for confounding variables, multivariate analysis (Table 4) shows that those who had no children were more likely to expect >3 children than those with at >1 child (adjusted OR: 5.27, CI: 1.39-19.90), and better most-recent CD4 count significantly reduces the odds of expecting >3 children (adjusted OR: 0.98, CI: 0.96-0.99). Thus, the fertility history and result of the most-recent CD4 count of the respondents are important determinants of their intention to have >3 children as against 1-2 children in the future.

Table 5. Responses to question on reproductive options given by healthcare providers (N=107)

A total of 107 (72.8%) respondents admitted to have been previously counseled on sexuality and fertility issues by healthcare providers at the CSS clinic or elsewhere. The responses to questions on the advice given by their counselors with respect to reproductive decisions are listed in Table 5. Over half of the respondents reported being advised to report to the clinician with their partner for further information when ready for pregnancy. Regardless of their desire for children, 53.1% of all the study participants felt that healthcare providers would not sufficiently address personal issues, such as sexuality and fertility desires.