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

Characteristics	n(%)	Characteristics	n(%)
Sex		Receiving HAART
Male	52 (35.4)	Yes	74 (50.3)
Female	95 (64.6)	No	73 (49.7)
Age (Years]		Estimated Monthly Income (Naira)
<20	4 (2.7)	<5,000	89 (60.5)
21-30	33 (22.4)	5,001-10,000	22 (15.0)
31-40	64 (43.5)	10,001-20,000	18 (12.2)
41-50	34 (23.1)	>20,000	18 (12.2)
>50	12 (8.2)
		Relationship Status
Religion		Never-married	12 (8.2)
Islam	33 (22.4)	Married	64 (43.5)
Christianity	114 (77.6)	Nonmarried partner	18 (12.2)
		Separated/divorced	21 (14.3)
Tribe		Widowed	32 (21.8)
Yoruba	131 (89.1)
Ibo	4 (2.7)	Educational Level
Hausa	0 (0.0)	None	2(1.4)
Others	12 (8.2)	Primary	31 (21.1)
		Secondary	96 (65.3)
Duration Since Diagnosis of HIV Infection (Months)		Postsecondary	18 (12.3)
0-12	36 (24.5)
13-24	33 (22.4)	Recent CD4 Count (cells/mm3)
25-48	50 (34.0)	<100	2(1.4)
>49	28 (19.1)	100-199	42 (28.6)
		200-499	59 (40.1)
Number of Children Alive		>500	44 (29.9)
0	30 (20.4)
1	43 (29.3)	Disclosure to Spouse/Partner
2	16 (10.9)	Yes	54 (65.9)
>3	58 (39.5)	No	28 (34.1)
Currently Employed
Yes	124 (84.9)
No	22 (15.1)

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

Characteristics	Men	Women	P
	n=95	n=52
Fertility Desires
Desires children:
Yes	53.8	68.4	0.0796*
No	46.2	31.6
Fertility Intentions^
Number of children expected:
0	14.3	0.0	0.0000*
1	14.3	6.2
2	42.9	52.3
>3	28.6	41.5
Partner’s Fertility Desires*
Yes	47.1	70.8	0.0000*
No	41.2	16.7
Do not know	11.8	12.5
t Among those who desire children (n=		=93); * Among those
with partners (n=82); J By Chi-squared test

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

Characteristics	Desire Children	Do Not Desire Children	PValue	Adjusted OR (95% CI)	Adjusted P Value
Age (years): mean ± SD (range)	32.3 ±7.8 (18-55)	42.8 ± 6.0 (32-55)	0.0000*	0.83 (0.73-0.93)	0.0033
SexFemale (%) Male (%)	69.9 30.1	55.6 44.4	0.0796*
Marriage Status Currently married Other	38.7 61.3	51.9 41.1	0.1213*
Has>l ChildNo Yes	32.3 67.7	0.0 100.0	0.0000§
Estimated monthly income (N): median (interquartile range)	4,000 (2,000-9,000)	6,000 (4,000-25,000)	0.0009*	1.00(1.00-1.01)	0.4098
Duration since diagnosis of HIV (months): mean ± SD (range)	23.8 ± 18.5(1.0-96.0)	33.4 ±21.1 (3.0-95.0)	0.0076*	0.96 (0.90-0.99)	0.0447
Duration of HIV clinic attendance (months): mean ± SD (range)	16.3 ± 12.9 (1.0-53.0)	26.5 ± 15.3 (3.0-51.0)	0.00011	1.00(0.93-1.08)	0.9664
Disclosed to partner (%)	52.0	87.5	0.0009*	0.01 (0.00-0.17)	0.0010
Receiving HAART (%)	43.0	63.0	0.0196*	0.18(0.02-1.82)	0.1476
Physical functioning: mean ± SD (range)	9.3 ± 1.5 (3.0-10.0)	8.4 ±2.0 (3.0-10.0)	0.0018*	1.04 (0.55-1.96)	0.8922
Self-reported overall health:mean ± SD (range)         9.1+1.3 (5.0-10.0)		8.1± 2.1 (3.0-10.0)	0.0045*
Latest CD4+ count (cells/mm3): mean ± SD (range)	209.9 ± 68.9 (60-340)	284.7 ± 151.7 (12CMS20)	0.0305*
Lowest CD4+ count ever (cells/mm3): mean ± SD (range)	191.4±71.8 (60-340)	209.3 ±58.0 (120-301)	0.1596*
Emotional Well-Being (%)Happy Sad Calm and peaceful Depressed	50.5 19.4 30.1	66.7 11.1 22.2	0.1513*
WHO Performance Score ( 1II	%) 65.6 34.4	63.0 37.0	0.747*
t By Mann-Whitney U test; t By x2 test; § By Fisher’s exact test; * By t test; N: Naira; Adjusted OR: adjusted odds ratio in logistic regression analysis; CI: confidence interval

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

Expects 1-2 Characteristics          Children	Expects >3 Children	PValue	Adjusted OR (?5%CI)	Adjusted P Value
Age (years): mean ± SD(range)                    32.3 ± 7.5 (20-55)	30.6 ±8.5 (18-54)	0.1702*	1.01 (0.92-1.11)	0.8099
SexFemale (%)               70.4 Male (%)                  29.6	77.1 22.9	0.4818*
Has>l ChildNo                         18.5 Yes                         81.5	57.1 42.9	0.00016*	5.27 (1.39-19.90) 1.0 (ref)	0.0141
Awareness ofpartner’s status          53.3	33.3	0.1475§
Partner desires fertility   88.2	100.0	0.2845§
Estimated monthly income(N): median (interquartile range)                     4,000 (2,000-8,000)	3,500 (1,500-5,000)	0.1042+	0.99 (0.99-1.00)	0.3426
Duration since diagnosis of HIV (months): median (interquartile range)     22.0 (13.0-25.0)	23.0 (3.0-42.0)	0.6787+
Duration of HIV clinic attendance (months):mean ± SD (range)      16.5 ± 12.5 (1.0-53.0)	15.4 ± 14.1 (1.0-42.0)	0.7161 +
Disclosure to partner (%) 60.0	44.4	0.2950*
Receiving HAART (%)    48.1	34.3	0.1965*
Latest CD4+ count(cells/mm3): mean ± SD (range)                    224.2 ± 67.1 (100-321)	178.1 ± 54.8(60-250)	0.0040*	0.98 (0.96-0.99)	0.0063
Lowest CD4+ count ever(cells/mm3): mean ± SD (range)                    201.0 ± 68.2 (90-321)	170.0 ± 64.0 (60-250)	0.0637*
Self-reported overall health:mean ± SD (range)      9.3 ± 1.1 (5.0-10.0)	8.9 ±2.2 (5.0-10.0)	0.1123*
Physical functioning:mean ± SD (range)      9.5 ± 1.0 (7.0-10.0)	8.8 ±2.0 (3.0-10.0)	0.0843+	0.82 (0.50-1.33)	0.4261
Emotional Well-Being (%) Happy                    59.3 Sad                        14.8 Calm and peaceful     25.9 Depressed	42.9 28.6 28.6	0.0000*	1.0 (ref)0.33 (0.11-1.72) 0.62 (0.14-2.75)	0.0948 0.5339
WHO Performance Score (%)I                                            70.4 II                                           29.6	60.0 40.0	0.3120*
t By Mann-Whitney U test; | By x2 test; § By Fisher’s exact test; * By t-test; N: Naira; Adjusted OR: adjusted odds ratio in logistic regression analysis; CI: confidence interval; ref: reference category

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)

	n	(%)
Not to ever get pregnant/impregnate someone/have more children	15	(14.0)
To have as many children as 1 wish anytime	2	(1.9)
Not to use condom at midcycle /time of ovulation	2	(1.9)
To get pregnant/impregnate someone only when 1 am on antiretroviral drugs	10	i (9.3)
To come and see the clinician for further information when ready for pregnancy	60	(56.1)
To have children only with an HIV-positive partner	9	(8.4)
To report immediately for antenatal care once pregnant	9	(8.4)

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.