The potential impact of antiretroviral therapy on fertility in sub-Saharan Africa

Abstract

Approximately 14 million women of child-bearing age are living with HIV/AIDS in sub-Saharan Africa. Women with HIV infection have between 25% and 40% lower fertility than noninfected women. As antiretroviral (ARV) therapy becomes increasingly accessible in sub-Saharan Africa, it is important to understand whether and how the associated clinical improvements correspond with changes in the incidence of pregnancy and fertility. Accordingly, this paper reviews the literature on the potential impact of ARV therapy on the fertility of women with HIV infection in sub-Saharan Africa. We use Bongaarts' proximate determinants of fertility framework (adapted for conditions of a generalized HIV epidemic) to examine the underlying mechanisms through which use of ARV therapy may impact the fertility of women with HIV infection. A conceptual framework is proposed to guide future research aimed at understanding how widespread use of ARV therapy may impact fertility in sub-Saharan Africa.

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

“…53,54 HIV status and HAART use alone are unlikely to be the sole or even primary drivers of reproductive decision making. 23 Indeed, qualitative studies have highlighted that the desire for motherhood, opinions of partners and health care providers, religious values, and the perceived capacity to successfully parent emerge as critical factors influencing the childbearing decision making of HIV-positive women.…”

“…4,22 Expanding access to highly active antiretroviral therapy (HAART) is changing the landscape of childbearing decision making for people living with HIV. 23 HAART increases life expectancy, [24][25][26] decreases morbidity, 25,27 and dramatically reduces the risks of vertical 28 and horizontal 29,30 transmission. In this era of expanding access to HAART, the significant reduction in health risks and barriers to reproduction among people living with HIV has coincided with increased calls for a rights-and evidenced-based approach to reproduction.…”

“…Overall, we hypothesized that HAART use would narrow the measurable differences in childbearing intentions between HIV-positive and HIV-negative women. 23 …”

Antiretroviral Therapy is Associated with Increased Fertility Desire, but not Pregnancy or Live Birth, among HIV+ Women in an Early HIV Treatment Program in Rural Uganda

“…We based our study on a conceptual framework proposed by Kaida that details the biological, behavioral, economic, and social factors that may mediate ART's influence on fertility (Kaida et al 2006). We hypothesized that ART use may increase fertility and fertility desires among HIV-positive women (compared with those not on therapy) through three mechanisms.…”

Perceptions of HIV and Fertility Among Adolescents in Soweto, South Africa: Stigma and Social Barriers Continue to Hinder Progress

“…In fact, the success of HAART has reduced MTCT rates to approximately 1-2 percent (Volmink, Siegfried, van der Merwe, & Brocklehurst, 2007 (Kaida, et al, 2006).…”