Fertility Desires and Intentions and the Relationship to Consistent Condom Use and Provider Communication Regarding Childbearing Among HIV Clients in Uganda.

Glenn J Wagner,Rhoda Wanyenze

doi:10.5402/2013/478192

Abstract

HIV prevention and reproductive health programs emphasize consistent condom use and preventing unplanned pregnancies, but do not account for the childbearing desires of many HIV clients. We examined the correlates of fertility desires and intentions, including condom use, among HIV clients in Uganda. Baseline data from a prospective cohort study of clients starting antiretroviral therapy were analyzed. All measures were self-report, except abstracted CD4 count. The sample included 767 clients; 34% were men and 50% had a primary sex partner. Among those with a desire (31%) or intention (24%) for having a child in the near future, 60% had not discussed this with providers. A majority (61%) had received advise about family planning, and 27% were told by their provider that they should not bear a child because of their HIV status. In regression analysis, male gender, younger age, higher CD4, having fewer children, and having a primary partner were significantly associated with fertility desires and intentions; having been told by one's provider not to have a child was associated with intentions but not desires. Among participants with a primary partner, consistent condom use was greater among those with no fertility intentions, as was receipt of advise about family planning, while HIV disclosure to partner was greater among those with intentions. Partner HIV status was not associated with fertility desires or intentions. These findings highlight the need for HIV care and reproductive health programs to incorporate safer conception counseling and improve provider/patient communication regarding childbearing.

Highlights

Pregnancy in persons living with HIV/AIDS (PLHIV) involves signi cant public health risks including risks of HIV transmission to uninfected partners (30–40% of HIVaffected couples are serodiscordant) [1] and the fetus
We examined whether clients with a primary sex partner who had intentions to bear children were less likely to use condoms consistently, and whether fertility intentions and condom use were associated with relationship factors such as HIV disclosure to the partner, the partner’s HIV status, and communication between the client and providers regarding family planning and childbearing
Participants were paid 10,000 Uganda shillings to complete the interview, which is consistent with other survey research conducted in the country and is considered an appropriate amount by the Uganda National Council for Science and Technology (UNCST). e study protocol was approved by the Makerere University Research and Ethics Committee, as well as the UNCST

Summary

Introduction

Pregnancy in persons living with HIV/AIDS (PLHIV) involves signi cant public health risks including risks of HIV transmission to uninfected partners (30–40% of HIVaffected couples are serodiscordant) [1] and the fetus. While prophylactic antiretroviral therapy can prevent mother-tochild transmission [2], over half of the pregnants PLHIV in sub-Saharan Africa do not use such treatment [3]. Reproductive health programs emphasize preventing pregnancies and use of contraceptives, including consistent condom use [7]. This approach does not account for the fact that 20–50% of PLHIV in sub-Saharan Africa want to have children [1, 4, 8,9,10,11,12]. Number of children that the patient had parented was assessed, and whether or not the respondent or their partner was currently pregnant or had given birth to a child within the past 12 months

Methods

Results

Conclusion