Does Knowledge About Antiretroviral Therapy and Mother-to-Child Transmission Affect the Relationships Between Hiv Status and Fertility Preferences and Contraceptive Use? New Evidence From Nigeria and Zambia

Abstract

The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009-2010 community-based surveys in Nigeria and Zambia, this study explores whether women's knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women's HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.

Pregnancy Intent Among a Sample of Recently Diagnosed HIV-Positive Women and Men Practicing Unprotected Sex in Cape Town, South Africa

“…In our study, nearly two-thirds of the women had shared their HIV status with their partners, and in the multiple regression analysis, women whose partners were aware of their status had almost 6 times higher odds of desiring to conceive in the next 6 months compared with those who had not. This association was not found in Phaweni's study of HIV-positive women recruited from antenatal services in Mpumalanga, South Africa, 40 perhaps because these women had recently given birth. Our findings indicated that disclosure had already occurred among many women interested in conceiving, suggesting that partners could join them directly in pre-conception counseling about safer conception.…”

“…Previous research suggests that determinants of pregnancy intent among HIV-positive persons include personal characteristics and circumstances (younger age of mother, 29 , 33 , 34 being male 13 ); longer time living with HIV/AIDS 21 , 34 , 35 ; better perceived and actual health status 16 , 21 ; being on ARVs 36 ; knowledge (eg, of preventing vertical transmission and ARVs) 12 , 33 , 37 ; reproductive factors (fewer biological children 16 , 21 , 34 , 38 , 39 ); interpersonal and social factors (non-disclosure of HIV status to partner 16 , 21 , 34 ); and geographical factors (by country). 40 However, in the literature to date, there is limited comparison of gender differences in fertility intent and of the factors that lead newly diagnosed HIV-positive individuals to desire children in the immediate future. Among HIV-positive persons who do not use condoms consistently, it is unclear how many do so because of fertility desires.…”

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study

“…HIV positive mother on the antiretroviral drug will be with the low viral load so that there is less probability of transmitting to the child through pregnancy, childbirth, and breastfeeding. Mother on chronic HIV care would be with better knowledge of PMTCT and adhered to the recommended prevention mechanism [26]. …”

Attitudes of women and men living with HIV and their healthcare providers towards pregnancy and abortion by HIV-positive women in Nigeria and Zambia

“…Desired fertility is of course a culturally-specific construct. Again using data from the HIV and Achieving Fertility Desires project, Bankole et al (2014b) found that women with HIV in Nigeria were more likely to want more children than were women with HIV in Zambia.…”