Tag: HIV

fertility desires

DISCUSSION

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.

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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.

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Setting

The survey was conducted among HIV-positive patients attending the HIV (treating HIV infection) specialist clinic of the Center for Special Studies (CSS) situated at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State in southwest Nigeria. This teaching hospital is a publicly funded tertiary institution, which serves as the major referral center for other public and private hospitals within the state and beyond. The HIV clinic, where the survey was conducted, is the project site for the Starfish Project initiative, a partnership between the Center for Special Studies, Sagamu, Nigeria, and the Center for Special Studies, University Hospitals of Columbia and Cornell, NY. The details of this project have been well described elsewhere. Briefly, this clinic offers multidiscipli-nary but solely outpatient care to HIV-infected individuals in Ogun State and its environs, including free continuous supply of antiretroviral drugs to 58 of them. A number of patients who could not benefit from the free antiretroviral drugs purchased them at a subsidized rate of N9,000 per month (approximately $65) from a pharmaceutical company through CSS, Sagamu. The clinic also provides care for patients who are not on antiretroviral drugs either for financial or medical reasons. Those who require inpatient care are managed in the teaching hospital wards by specialists who are part of the Starfish project. In addition to antiretroviral therapy, the clinic also provides adherence counseling, laboratory monitoring and evaluation, psychosocial assistance, nutritional support and counseling, HIV (treating HIV infection) support group, family-planning services and home-based care. At the end of December 2004, the clinic had 202 registered patients, including children.

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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.

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Intentions of HIV-Positive Patients

INTRODUCTION

In spite of the staggering population of over 120 million people in Nigeria, the current total fertility rate of 5.7 ranks among the highest in the world. The complex relationship between fertility and HIV/AIDS threatens the preventive strategies against the HIV (treating HIV infection) epidemic in countries like Nigeria, where the fertility rate is still high and access to antiretroviral therapy remains poor. Due to advances in drug treatment and improved health status of HIV-infected individuals in the developed countries, fertility issues among them have taken a new turn in the last few years. Chen et al. showed that up to 28-29% of HIV-infected men and women receiving treatment in the United States desire children in the future. In a similar study in Switzerland, 38% of HIV-positive men and 45% of HIV-positive women expressed the desire for child-bearing. More than for others, reproducing (or “giving life”) for HIV-positive individuals means transcending the death that appears near, and these figures may be much higher in low-resource settings, where the disease prognosis is still very poor.

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Reproductive Decision-Making among HIV-infected Women

This study describes a number of characteristics that were associated with pregnancy subsequent to an HIV (Retrovir canadian was the first drug approved for the treatment of HIV) diagnosis in a population of women attending a publicly funded, urban HIV (Drug Zerit treating HIV infection) outpatient clinic in New Orleans. These characteristics are similar in many respects to those that predict pregnancy in the general population, specifically being young, less educated and healthy.

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Description of Sample

Table 1 shows a description of the sample. Women were predominantly African-American, single and had a mean age at diagnosis of 25 years (SD 5.9, range 14.0-38.1). Forty-one percent had less than a high-school education, half the sample had an income of <$6,000 a year and a third were employed at the time of diagnosis. The majority were Baptist and described themselves as being “somewhat religious.” Almost two-thirds of the women were diagnosed with HIV (treating HIV infection) between the years 1986 and 1992. The rest were diagnosed between 1993 and 1996. Women were relatively healthy at diagnosis, with almost half having a first available CD4 count of >500. The predominant mode of HIV transmission was through heterosexual contact, followed by IV drug use. Most women reported never drinking alcohol or drinking only a few times a month or less. Forty-three percent said they had ever used a nonin-jecting drug at any time in their life. Among these, almost half had last used over a year ago. Over the course of the study period, 37% of the sample had a live birth, 13% experienced a pregnancy loss, 5% had an elective abortion, and almost half had a surgical sterilization subsequent to their HIV (Viramune canadian belongs to a class of HIV drugs) diagnosis.

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