Bucking social norms: Examining anomalous fertility aspirations in the face of HIV in Lusaka, Zambia

Abstract

In settings of high fertility and high HIV prevalence, individuals are making fertility decisions while simultaneously trying to avoid or manage HIV. We sought to increase our understanding of how individuals dually manage HIV risk while attempting to achieve their fertility goals as part of the project entitled HIV Status and Achieving Fertility Desires conducted in Zambia in 2011. Using multivariate regression to predict fertility patterns based on socio-demographic characteristics for respondents from facility-based and community-based surveys, we employed Anomalous Case Analysis (ACA) whereby in-depth interview respondents were selected from the groups of outliers amongst the survey respondents who reported lower or higher fertility preferences than predicted as well as those who adhered to predicted patterns, and lived in Lusaka (n=45). All of the facility-based respondents were HIV-positive. We utilize the Theory of Conjunctural Action (TCA) to categorize domains of influence on individuals’ preferences and behavior. Both community-based and facility-based right-tail respondents (outliers whose fertility intentions indicated that they wanted a/nother child when we predicted that they did not) expressed comparatively less control over their fertility and gave more weight to pressures from others to continue childbearing. Partner communication about fertility desires was greater among left-tail respondents (outliers whose fertility intentions indicated that they did not want a/nother child when we predicted that they did). HIV-positive right-tail respondents were more likely to see anti-retroviral therapies (ARTs) which prevent mother to child transmission of HIV as highly effective, mitigating inhibitions to further childbearing. Drug interactions between ARTs and contraceptives were identified as a limitation to HIV-positive individuals’ contraceptive options on both sides of the distribution. Factors that should be taken into account in the future to understand fertility behavior in high HIV-prevalent settings include couples’ communication around fertility and perception of the efficacy of ARTs.

Pandemic and hospital avoidance: Evidence from the 2015 Middle East respiratory syndrome outbreak in South Korea

“…Existing literature shows that during contagious disease outbreaks, people exhibit disease avoidance behaviors. For instance, behaviors reported in response to the HIV outbreak include pregnancy avoidance ( Kaida et al, 2011 , Moore et al, 2014 ), reduced frequency of sexual activity ( Gregson et al, 1998 ), and increased condom usage ( Ahituv et al, 1996 ). Following outbreaks of respiratory diseases such as the severe acute respiratory syndrome (SARS) in 2003 and the novel influenza virus A (H1N1) pandemic in 2009, hospital avoidance ( Bennett et al, 2015 ) and increased handwashing ( Jones and Salathe, 2009 , Agüero and Beleche, 2017 ) were reported.…”

Partner’s profile and unmet need for child limiting among women living with HIV in Ibadan, Nigeria

“…Among women living with HIV, the marriage dynamics is peculiar because quite a number of such women are in higher order marriages, having lost their previous spouses to death or divorce [18,19]. Some of these remarried women are often not interested in childbearing but just to be recognized as been in conjugal relationship with a man [20,21]. Therefore, the role of partner-related factors in unmet need for child limiting deserves further exploration.…”