December 9, 2002
Many studies lack consideration of the effect of intention to bear offspring on reproduction following HIV diagnosis. In developed countries, HIV diagnosis appears to lead many women to avoid pregnancy or to undergo pregnancy termination, decisions that may be attributed in part to availability of and access to voluntary counseling and testing (VCT), modern contraception, and safe and legal abortion services. By contrast, studies in several African countries have suggested that HIV diagnosis has little effect on subsequent childbearing. Yet, one limitation of these studies is that none have directly examined the effect of intention to reproduce on reproduction following HIV diagnosis.
The authors examined the association of intention to bear children and knowledge of HIV serostatus with subsequent reproductive behavior among men and women receiving HIV voluntary counseling and testing in Kenya and Tanzania. In addition to providing descriptive analyses, the authors tested the direct and interactive effects of HIV serostatus and intention to reproduce on pregnancy status 6 months post-VCT. Assuming that the desire to avoid vertical transmission would outweigh contextual factors favoring reproduction among infected individuals, the authors hypothesized that participants diagnosed with HIV infection who also reported intention to reproduce before learning their serostatus would be less likely than uninfected participants to be pregnant or to have a pregnant partner 6 months post-VCT.
All participants included in this analysis were drawn from the Voluntary HIV Counseling and Testing Efficacy Study, a randomized controlled trial evaluating the efficacy of VCT in changing sexual risk behavior among adults in Nairobi, Kenya, and Dar es Salaam, Tanzania. The target study population included individuals and couples seeking HIV-related services in an urban public hospital in Dar es Salaam and a free-standing clinic in a low-income suburban settlement in Nairobi.
There were 2,942 eligible participants for primary data analysis. The authors then excluded participants based on sexual abstinence, being pregnant, men 60 years or older, women 40 years or older, same sex partners and women with a history of tubal ligation, leaving 1,634 eligible participants for secondary analysis.
The authors found that women who were younger, not using contraception, aware of the risk of vertical transmission, and HIV infected were more likely than those with the opposite characteristics to be pregnant at time 2. Although pregnancy planning showed no main effect on pregnancy status for women, fewer of those who tested negative reported a pregnancy at 6 months post-VCT.
Taken together, these findings suggest that diagnosis with HIV may have precipitated a reduction in fertility among less healthy women, independent of the effects of relationship status, number of children, and frequency of sexual activity. Men who were younger, married or cohabitating, not using contraception, and aware of risks of vertical transmission were more likely to report that their partners were pregnant at 6 months post-VCT, regardless of their HIV serostatus. The latter findings suggest that men's awareness of their HIV serostatus and baseline intention to reproduce were unrelated to partner pregnancies reported 6 months later.
"HIV diagnosis may influence reproduction planning for women but not for men," the authors wrote. "Future VCT intervention research would do well to tailor protocols to appeal to men and increase their participation, incorporate family planning issues in VCT programming (including alternatives to child-bearing), and enhance VCT messages to appeal to participants' desire to ensure the well-being of their offspring."
American Journal of Public Health
11.02; Vol. 92; No. 11: P. 1795-1800; Andrew D. Forsyth, Ph.D.; Thomas J. Coates, Ph.D.; Olga A. Grinstead, Ph.D., M.P.H.; Gloria Sangiwa, M.D.; Donald Balmer, Ph.D.; Munkolenkole C. Kamenga, M.D.; Steven E. Gregorich, Ph.D.