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Factors Associated with Intention to Conceive and its Communication to Providers Among HIV Clients in Uganda

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Abstract

Persons living with HIV/AIDS (PLHA) must discuss their fertility intentions with healthcare providers to receive the support needed to have children safely and limit transmission risks. However, few quantitative studies have examined correlates of fertility intentions, let alone the communication of such intentions with providers. We examined the prevalence and correlates of intentions to have children, and comfort discussing such plans with one’s providers, in HIV clients at two HIV clinics in Uganda. Cross-sectional self-report data were collected from 233 patients who had primary partners. Bivariate correlates significant at the P < 0.10 level were included in logistic regression analysis. Of the 233 participants, 103 (44%) reported an intention to conceive a child in the near future. In multivariate analysis, younger age of both the patient and their partner, better physical health functioning and higher internalized HIV stigma were associated with having fertility intentions. One-third (35%) of those with fertility intentions expressed having difficulty discussing these intentions with their providers, which was associated with receiving care at the rural clinic and greater internalized HIV stigma. These findings highlight the need for reproductive health services that help clients accept themselves as PLHA and their fertility rights, thus promoting patient-doctor communication needed to promote safe child conception and delivery outcomes.

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References

  1. United Nations Programme on HIV/AIDS (2010). AIDS Epidemic Update 2009. Available http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2009/default.asp. Accessed on 8 Sep 2010.

  2. Ivers, L. C., Kendrick, D., & Doucette, K. (2005). Efficacy of antiretroviral therapy programs in resource-poor settings: A meta-analysis of the published literature. Clinical Infectious Diseases, 41, 217–224.

    Article  PubMed  CAS  Google Scholar 

  3. Tai, J. H., Udoji, M. A., Barkanic, G., Byrne, D. W., Rebeiro, P. F., Byram, B. R., et al. (2007). Pregnancy and HIV disease progression during the era of highly active antiretroviral therapy. Journal of Infectious Diseases, 196, 1044–1052.

    Article  PubMed  Google Scholar 

  4. Agadjanian, V., & Hayford, S. R. (2009). PMTCT, HAART, and childbearing in Mozambique: An institutional perspective. AIDS and Behavior, 13(Suppl 1), 103–112.

    Article  PubMed  Google Scholar 

  5. Kaida, A., Andia, I., Maier, M., et al. (2006). The potential impact of antiretroviral therapy on fertility in sub-Saharan Africa. Current HIV/AIDS Reports, 3, 187–194.

    Article  PubMed  Google Scholar 

  6. Myer, L., Morroni, C., & Rebe, K. (2007). Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDs, 21, 278–285.

    Article  PubMed  Google Scholar 

  7. Taulo, F., Berry, M., Tsui, A., et al. (2009). Fertility intentions of HIV-1 infected and uninfected women in Malawi: A longitudinal study. AIDS and Behavior, 13(Suppl 1), 20–27.

    Article  PubMed  Google Scholar 

  8. Cooper, D., Moodley, J., Zweigenthal, V., et al. (2009). Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: Implications for integrating reproductive health and HIV care services. AIDS and Behavior, 13, 38–46.

    Article  PubMed  Google Scholar 

  9. Homsy, J., Bunnell, R., Moore, D., et al. (2009). Reproductive intentions and outcomes among women on antiretroviral therapy in Rural Uganda: A prospective cohort study. PLos One, 4, 1–10.

    Article  Google Scholar 

  10. Allen, S., Meinzen-Derr, J., Kautzman, M., et al. (2003). Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS, 17, 733–740.

    Article  PubMed  Google Scholar 

  11. Preston-Whyte, E. (1988). Culture, context and behavior: Anthropological perspectives on fertility in Southern Africa. South African Journal of Demography, 2, 13–23.

    CAS  Google Scholar 

  12. Sonko, S. (1994). Fertility and culture in sub-Saharan Africa: A review. International Social Science Journal, 46, 397–411.

    Google Scholar 

  13. Beyeza-Kashesya, J., Kaharuza, F., Mirembe, F., et al. (2009). The dilemma of safe sex and having children: Challenges facing HIV sero-discordant couples in Uganda. African Health Sciences, 9, 2–12.

    PubMed  Google Scholar 

  14. Maier, M., Andia, I., Emenyonu, N., et al. (2009). 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. AIDS and Behavior, 13, 28–37.

    Article  PubMed  Google Scholar 

  15. Oladapo, O. T., Daniel, O. J., Odusoga, O. L., & Ayoola-Sotubo, O. (2005). Fertility desires and intentions of HIV-positive patients at a suburban specialist center. Journal of the National Medical Association, 97, 1672–1681.

    PubMed  Google Scholar 

  16. Ronsmans, C., Etard, J. F., Walraven, G., Hoj, L., Dumont, A., de Bernis, L., et al. (2003). Maternal mortality and access to obstetric services in West Africa. Tropical Medicine and International Health, 8, 940–948.

    Article  PubMed  CAS  Google Scholar 

  17. Stringer, E. M., Ekouevi, D. K., Coetzee, D., Tih, P. M., Creek, T. L., Stinson, K., et al. (2010). Coverage of nevirapine-based services to prevent mother-to-child-transmission in 4 African countries. JAMA, 304, 293–302.

    Article  PubMed  CAS  Google Scholar 

  18. Uganda AIDS Commission (UAC). (2009). The Uganda HIV modes of transmission and prevention response analysis. Uganda: UAC Kampala.

    Google Scholar 

  19. Merson, M. (2006). Uganda’s HIV/AIDS epidemic: Guest editorial. AIDS and Behavior, 10, 333–334.

    Article  Google Scholar 

  20. Kaida, A., Lima, V. D., Andia, I., et al. (2009). The WHOMEN’s scale (Women’s HAART Optimism Monitoring and EvaluatioN Scale v.1) and the association with fertility intentions and sexual behaviours among HIV-positive women in Uganda. AIDS and Behavior, 13(Suppl 1), 72–81.

    Article  PubMed  Google Scholar 

  21. Nduna, M., & Farlane, L. (2009). Women Living with HIV in South Africa and Their Concerns About Fertility. AIDS and Behavior, 13, 62–65.

    Article  PubMed  Google Scholar 

  22. Feldman, R., & Maposhere, C. (2003). Safer sex and reproductive choice: Findings from “positive women: Voices and choices” in Zimbabwe. Reprod Health Matters, 11, 162–173.

    Article  PubMed  Google Scholar 

  23. Nattabi, B., Li, J., Thompson, S. C., Orach, C. G., & Earnest, J. (2009). A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: Implications for policy and service delivery. AIDS and Behavior, 13, 949–968.

    Article  PubMed  Google Scholar 

  24. Harries, J., Cooper, D., Myer, L., et al. (2007). Policy maker and health care provider perspectives on reproductive decision-making amongst HIV-infected individuals in South Africa. BMC Public Health, 7, 282.

    Article  PubMed  Google Scholar 

  25. Nostlinger, C. M., Gordillo, V., Borms, R., et al. (2008). Differences in perceptions on sexual and reproductive health between service providers and people living with HIV: A qualitative elicitation study. Psychology, Health, and Medicine, 13, 516–528.

    Article  PubMed  Google Scholar 

  26. Grosh, M., & Glewwe, P. (2000). Designing household survey questionnaires for developing countries: Lessons from 15 Years of the Living Standards Measurement Study. Vol 1, 2, and 3. Washington, DC: The World Bank.

    Google Scholar 

  27. Rose, D., & Oliveira, V. (1997). Nutrient intakes of individuals from food-insufficient households in the United States. American Journal of Public Health, 87, 1956–1961.

    Article  PubMed  CAS  Google Scholar 

  28. Mast, T. C., Kigozi, G., Wabwire-Mangen, F., et al. (2004). Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care, 16, 81–94.

    Article  PubMed  CAS  Google Scholar 

  29. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

    Article  PubMed  CAS  Google Scholar 

  30. Monahan, P. O., Shacham, E., Reece, M., et al. (2009). Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in Western Kenya. Journal of General Internal Medicine, 24, 189–197.

    Article  PubMed  Google Scholar 

  31. Kalichman, S. C., Simbayi, L. C., Jooste, S., et al. (2005). Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS and Behavior, 9, 135–143.

    Article  PubMed  Google Scholar 

  32. Chesney, M. A., Ickovics, J. R., Chambers, D. B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. AIDS Care, 12, 255–266.

    Article  PubMed  CAS  Google Scholar 

  33. Central Intelligence Agency. (2009). The world factbook. Washington, DC. https://www.cia.gov/library/publications/the-world-factbook/index.html.

  34. Rutstein, S. O., & Shah, I. H. (2004). Infecundity, infertility and childlessness in developing countries. Calverton: ORC Macro.

    Google Scholar 

  35. Smith, D. J., & Mbakwem, B. C. (2010). Antiretroviral therapy and reproductive life projects: Mitigating the stigma of AIDS in Nigeria. Social Science and Medicine, 71, 345–352.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research is supported by a grant from the Rockefeller Foundation. We would also like to thank the study coordinators (Tonny Kizza, Joseph Bebe, Mark Magina), the clinic directors (Drs. William Tamale and Grace Namayanja), nurse Erina Turya, and counselors (Hellen Nakyambadde, Rose Byaruhanga, Grace Barungi) who helped to identify and refer participants, and the client participants who gave so generously of their time and their personal stories to inform the study.

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Authors and Affiliations

  1. RAND, Santa Monica, CA, USA

    Glenn Wagner & Sebastian Linnemayr

  2. Joint Clinical Research Center, Kampala, Uganda

    Cissy Kityo & Peter Mugyenyi

Authors
  1. Glenn Wagner
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  2. Sebastian Linnemayr
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  3. Cissy Kityo
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  4. Peter Mugyenyi
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Correspondence to Glenn Wagner.

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Wagner, G., Linnemayr, S., Kityo, C. et al. Factors Associated with Intention to Conceive and its Communication to Providers Among HIV Clients in Uganda. Matern Child Health J 16, 510–518 (2012). https://doi.org/10.1007/s10995-011-0761-5

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