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Behavioral or Biological: Taking a Closer Look at the Relationship Between HIV and Fertility

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Applied Demography and Public Health in the 21st Century

Part of the book series: Applied Demography Series ((ADS,volume 8))

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Abstract

This chapter examines the relationship between HIV infection and fertility among women in eight countries in Sub-Saharan Africa. The two most recent rounds of the Demographic and Health Surveys, which links women to their HIV test results, were used to distinguish between potential mechanisms linking HIV and fertility. HIV positive women had significantly lower fertility. The magnitude of the association between HIV status and fertility was consistent for women over the entire childbearing age and with different years of education. While HIV positive women desired fewer children compared to HIV negative women, the preference for smaller family sizes was not driving the relationship between HIV status and fertility. The relationship between HIV status and fertility held even after controlling for several indicators of risky sexual behavior, suggesting that changes in these indicators were not driving the observed relationship. HIV positive women had significantly lower fertility even after restricting the sample to respondents who had never been tested for HIV prior to the survey i.e. were presumed to be unaware of their HIV status and, thus, unlikely to be changing their behavior in response to their HIV infection. This provides evidence for a direct physiological effect of HIV infection on fertility.

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References

  • Bloom, S., Banda, C., Songolo, G., Mulendema, S., Cunningham, A., & Boerma, T. (2000). Looking for change in response to the AIDS epidemic: Trends in AIDS knowledge and sexual behavior in Zambia, 1900 Through 1998. Journal of Acquired Immune Deficiency Syndromes, 25, 77–85.

    Article  Google Scholar 

  • Carpenter, L. M., Nakiyingi, J. S., Ruberantwari, A., Malamba, S. S., Kamali, A., & Whitworth, Ja G. (1997). Estimates of the impact of HIV infection on fertility in a rural Ugandan population cohort. Health Transition Review, 7(1997), 113–126.

    Google Scholar 

  • Cheluget, B., Baltazar, G., Orege, P., Ibrahim, M., Marum, L. H., & Stover, J. (2006). Evidence for population level declines in adult HIV prevalence in Kenya. Sexually transmitted infections, 82(Suppl 1), i21–i26.

    Article  Google Scholar 

  • Fabiani, M., Nattabi, B., Ayella, E. O., Ogwang, M., & Declich, S. (2006). Differences in fertility by HIV serostatus and adjusted HIV prevalence data from an antenatal clinic in Northern Uganda. Tropical medicine & international health: TM & IH, 11(2), 182–187.

    Article  Google Scholar 

  • Fylkesnes, K., Musonda, R. M., Sichone, M., Ndhlovu, Z., Tembo, F., & Monze, M. (2001, February). Declining HIV prevalence and risk behaviours in Zambia: Evidence from surveillance and population-based surveys. AIDS, 15, 907–916.

    Article  Google Scholar 

  • Gray, R. H., Wawer, M. J., Serwadda, D., Sewankambo, N., Li, C., Wabwire-Mangen, F., et al. (1998). Population-based study of fertility in women with HIV-1 infection in Uganda. Lancet, 351, 98–103.

    Article  Google Scholar 

  • Gregson, S. (1994, November). Will HIV become a major determinant of fertility in sub-saharan Africa? Journal of Development Studies, 30, 650–679 (2014).

    Google Scholar 

  • Ho, D. E., Imai, K., King, G., & Stuart, E. A. (2007). Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference. Political Analysis, 15, 199–236.

    Article  Google Scholar 

  • Hunter, S. C., Isingo, R., Boerma, J. T., Urassa, M., Mwaluko, G., & Zaba, B. (2003). The association between HIV and fertility in a cohort study in rural Tanzania. Journal of Biosocial Science, 35, 189–199.

    Article  Google Scholar 

  • Integrated Demographic and Health Series. (2015). Demographic and health surveys 1988–2014. Data extract from DHS recode files. Integrated demographic and health series (IDHS), version 1.0, Minnesota Population Center and ICF International [Distributors]. Accessed from http://idhsdata.org

  • Juhn, C., Kalemli-Ozcan, S., & Turan, B. (2013). HIV and fertility in Africa: First evidence from population-based surveys. Journal of Population Economics, 26, 835–853.

    Article  Google Scholar 

  • Kaida, A., Andia, I., Maier, M., Strathdee, S. A., Bangsberg, D. R., Spiegel, J., et al. (2006). The potential impact of antiretroviral therapy on fertility in sub-saharan Africa. Current HIV/AIDS Reports, 3(4), 187–194.

    Article  Google Scholar 

  • Lewis, J., Ronsmans, C., Ezeh, A., & Gregson, S. (2004). The population impact of HIV on fertility in sub-saharan Africa. AIDS (London, England), 18(Suppl 2), S35–S43.

    Google Scholar 

  • Loko, M. A., Toure, S., Dakoury-Dogbo, N., Gabillard, D., Leroy, V., & Anglaret, X. (2005). Decreasing incidence of pregnancy by decreasing CD4 cell count in HIV-infected women in cote d’Ivoire: A 7-year cohort study. AIDS, 18, 439–445.

    Google Scholar 

  • Mishra, V., Vaessen, M., Boerma, J. T., Arnold, F., Way, A., Barrere, B., et al. (2006). HIV testing in national population-based surveys: Experience from the demographic and health surveys. Bulletin of the World Health Organization, 84(05), 537–545.

    Article  Google Scholar 

  • Oster, E. (2005). Sexually transmitted infections, sexual behavior, and the HIV/AIDS epidemic. The Quarterly Journal of Economics, 120(2).

    Google Scholar 

  • Palloni, A., & Rafalimanana, H. (1999). the effects of infant mortality on fertility revisited: New evidence from Latin America. Demography, 36(106), 41–58.

    Article  Google Scholar 

  • Pettifor, A. E., van der Straten, A., Dunbar, M. S., Shiboski, S. C., & Padian, N. S. (2004). Early age of first sex: A risk factor for HIV infection among women in Zimbabwe. AIDS, 18, 1435–1442.

    Article  Google Scholar 

  • Porter, L., Hao, L., Bishai, D., Serwadda, D., Wawer, M., Lutalo, T., et al. (2004). HIV status and union dissolution in sub-saharan Africa: The case of rakai. Uganda. Demography, 41(03), 465–482.

    Article  Google Scholar 

  • Ross, A., Van der Paal, L., Lubega, R., Mayanja, B., Shafer, L. A., & Whitworth, J. (2004). HIV-1 disease progression and fertility: The Incidence of recognized pregnancy and pregnancy outcome in Uganda. AIDS, 18, 799–804.

    Google Scholar 

  • Sneeringer, S. E., & Logan, T. (2009). A closer examination of the HIV/fertility linkage. Technical Report 63, MEASURE DHS.

    Google Scholar 

  • Terceira, N., Gregson, S., Zaba, B., & Mason, P. (2003, November). The contribution of HIV to fertility decline in rural Zimbabwe, 1985–2000. Population Studies, 57, 149–164 (2014).

    Google Scholar 

  • Young, A. (2005). The gift of the dying: The tragedy of aids and the welfare of future African generations. Quarterly Journal of Economics, 120(2).

    Google Scholar 

  • Young, A. (2007). In sorrow to bring forth children: Fertility amidst the plague of HIV. Journal of Economic Growth, 12, 283–327.

    Article  Google Scholar 

  • Zaba, B., & Gregson, S. (1998). Measuring the impact of HIV on fertility in Africa. AIDS, 12(Suppl 1), S41–S50.

    Google Scholar 

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Acknowledgments

Support for this research was provided by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant #5R24HD047879) and from the National Institutes of Health (training grant #5T32HD007163).

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Authors and Affiliations

  1. Office of Population Research, Princeton University, Princeton, NJ, 08544, USA

    Ayesha Mahmud

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  1. Ayesha Mahmud
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Correspondence to Ayesha Mahmud .

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Editors and Affiliations

  1. Hobby Center for Public Policy, University of Houston, Houston, Texas, USA

    M. Nazrul Hoque

  2. Institute for Demographic and and Socioeconomic Research, University of Texas at San Antonio, San Antonio, USA

    Beverly Pecotte

  3. Health Statistics Branch, Center for Public Health Practice, Arkansas Department of Health, Little Rock, Arkansas, USA

    Mary A. McGehee

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Mahmud, A. (2017). Behavioral or Biological: Taking a Closer Look at the Relationship Between HIV and Fertility. In: Hoque, M., Pecotte, B., McGehee, M. (eds) Applied Demography and Public Health in the 21st Century. Applied Demography Series, vol 8. Springer, Cham. https://doi.org/10.1007/978-3-319-43688-3_20

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  • DOI: https://doi.org/10.1007/978-3-319-43688-3_20

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43686-9

  • Online ISBN: 978-3-319-43688-3

  • eBook Packages: Social SciencesSocial Sciences (R0)

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