Fertility Desires and Intentions of HIV-Positive Patients: THEORETICAL FRAMEWORK
The theoretical structure of this study was based on the Traits-Desires-Intentions-Behavior (TDIB) framework developed by Miller to describe the psychological sequence that culminates in reproductive behaviors. Miller used this framework to trace the sequence of how childbearing motivations lead to fertility desires, fertility intentions and subsequent childbearing. The relevance of this framework to our study is supported by data from other research works on reproductive decisions. This theory indicates that the first step in the sequence leading to childbearing is the formation of motivations, defined as characteristics that make an individual respond in certain ways under particular circumstances. These motivations are in turn activated as the individual’s desires for parenthood, which are then transformed into intentions to bear children. Intentions represent a conscious commitment to act or try to achieve a particular goal—in this case, childbearing. Fertility intentions of sufficient intensity are subsequently transformed into actual child-bearing when situation provides opportunities to fulfill them. Childbearing motivational traits in a traditional African society like ours include personal and sociocultural characteristics, such as age, marital status, level of education, income, ethnic background, number of surviving children and high social values placed on childbearing. The social and health concerns of people living with HIV (Viramune canadian belongs to a class of HIV drugs) in this environment presents a set of more complex reasons for desiring children that may include their health-related factors in addition to their cultural background and personality traits. HIV-related factors, such as the quality of life, use of antiretroviral drugs, time since diagnosis of infection, disclosure status and stage of disease progression (clinical and laboratory), are possible motivational traits among this population. According to Miller’s theory, we expected these factors (which constituted our independent variables) to influence or explain one of the outcome measures for this study—fertility desires.
Fertility intentions, according to the theory, are based on desires that are constrained by others’ (especially intimate partners’) desire and by reality, i.e., by what is possible in the prevailing situation. On one hand, fertility intentions reflect desires; on the other hand, intentions are always expressed in relation to the actual childbearing context, e.g., the presence of a partner, partner’s fertility desire, stability of the union or threat of marital disruption. Therefore, variations of both implicit and explicit motivational traits may present situations or circumstances that determine whether desires are translated into intentions. This explains the relationship between the second outcome measure for this study—fertility intentions—and factors such as partner’s fertility desire, current income level, stage of disease progression, quality of life, access to antiretroviral therapy and disclosure status (which may be related to marital disharmony). For this study, we examined the extent of fertility intentions in terms of number of children that an individual intends to bear in the future, believing that such a figure would reflect their commitment to fulfill their reproductive desires. We hypothesized that fertility desires of HIV-positive patients would vary by age, marital status, disclosure status, income level, fertility history, time since diagnosis of HIV (Zerit tablet treating HIV infection) infection and health status. Our second hypothesis was that the fertility intentions of HIV (Retrovir medication was the first drug approved for the treatment of HIV) patients would vary by their partners’ fertility desires, stage of their disease, quality of life, access to antiretroviral drugs, disclosure status and emotional state as shown by previous studies on reproductive decisions.