Regardless of whether they are using antiretroviral therapy (ART), HIV-positive women in South Africa are less likely than their counterparts without HIV to intend to have children in the future.1 In a study of HIV clinic clients, approximately one-third of 18–44-year-old HIV-positive women (31% of ART users and 29% of never-users) reported wanting to have children, compared with more than two-thirds (68%) of their HIV-negative counterparts. In multivariate analyses, HIV-positive ART users and women who were HIV-positive but had never used ART had lower odds than HIV-negative women of intending to have children (odds ratios, 0.4 each); the childbearing intentions of ART users did not differ from those of HIV-positive women who had never used ART.
To examine whether women's childbearing intentions vary by their HIV status and use of ART, researchers recruited 18–49-year-old women seeking services from several clinics within the Perinatal HIV Research Unit—a large hospital-based HIV research and clinical service facility in Soweto, South Africa. Of the 801 women screened between May and December 2007, a total of 751 agreed to participate in the study and completed a questionnaire on their social and demographic characteristics, HIV status, history of ART use and childbearing intentions; the researchers reviewed women's medical records to confirm HIV status and ART history. For analyses of childbearing intentions, the sample was restricted to the 674 nonsterilized women aged 18–44, of whom 217 were HIV-positive and had been using ART for at least one month, 215 were HIV-positive and had never used ART, and 242 were HIV-negative. Two sets of multivariate analyses were conducted to examine whether women's childbearing intentions were independently associated with ART use: one set comparing HIV-positive women with those who were HIV-negative, and another comparing ART users with HIV-positive women who had never used the drugs.
The mean age of women in the sample was 30. Although only 8% of respondents reported being married, more than three-fourths (78%) were currently in a sexual relationship; 25% of those with a regular sex partner said that their partner was HIV-positive. On average, women had 1.4 children; 35% had one living child and 41% two or more. Forty-four percent of women reported planning to have a child or another child in the future. The proportion of women who intended to have children was greater among HIV-negative women (68%) than among HIV-positive ART users (31%) and HIV-positive women who had never used ART (29%).
In multivariate analyses of the full sample, HIV-positive ART users and never-users were less likely than women who were HIV-negative to plan to have a child in the future (odds ratios, 0.4 each). Being in a sexual relationship was positively associated with intending to have children (3.1), whereas having one or more living children was negatively associated with such intentions (0.1–0.3, depending on parity). In analyses of HIV-positive women, the childbearing intentions of ART users did not differ from those of never-users; as in the overall analyses, being in a sexual relationship was positively associated with intending to have children (3.0), and having living children was negatively associated with such intentions (0.1–0.4, depending on parity). Further analyses restricted to women aged 18–30—the peak childbearing years among women in South Africa—found the same associations between ART use and childbearing intentions as in the other analyses.
The finding that the childbearing intentions of HIV-positive South African women did not differ by ART use contrasts with the results of studies conducted in other Sub-?Saharan African countries, the investigators note; one possible explanation, they say, is that unlike their counterparts in some countries, HIV-?positive South African women who are not yet receiving ART "can be confident that treatment is available once they are medically eligible, thereby minimizing differences between groups." The researchers add that given the high prevalence of intentions to have children among HIV-positive women, "it is critical that factual and nonstigmatizing information and support be incorporated into HIV treatment services to optimize healthy outcomes for mother, father, and baby."
1. Kaida A et al., Childbearing intentions of HIV-positive women of reproductive age in Soweto, South Africa: the influence of expanding access to HAART in an HIV hyperendemic setting, American Journal of Public Health, 2011, 101(2):350–358.