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Fertility and HIV following universal access to ART in Rwanda: a cross-sectional analysis of Demographic and Health Survey data

Fertility and HIV following universal access to ART in Rwanda: a cross-sectional analysis of Demographic and Health Survey data
Fertility and HIV following universal access to ART in Rwanda: a cross-sectional analysis of Demographic and Health Survey data
Background
HIV infection is linked to decreased fertility and fertility desires in sub-Saharan Africa due to biological and social factors. We investigate the relationship between HIV infection and fertility or fertility desires in the context of universal access to antiretroviral therapy introduced in 2004 in Rwanda.

Methods
We used data from 3532 and 4527 women aged 20–49 from the 2005 and 2010 Rwandan Demographic and Health Surveys (RDHS), respectively. The RDHSs included blood-tests for HIV, as well as detailed interviews about fertility, demographic and behavioral outcomes. In both years, multiple logistic regression was used to assess the association between HIV and fertility outcomes within three age categories (20–29, 30–39 and 40–49 years), controlling for confounders and compensating for the complex survey design.

Results
In 2010, we did not find a difference in the odds of pregnancy in the last 5 years between HIV-seropositive and HIV-seronegative women after controlling for potential biological and social confounders. Controlling for the same confounders, we found that HIV-seropositive women under age 40 were less likely to desire more children compared to HIV-seronegative women (20–29 years adjusted odds ratio (AOR) = 0.31, 95% CI: 0.17, 0.58; 30–39 years AOR = 0.24, 95% CI: 0.14, 0.43), but no difference was found among women aged 40 or older. No associations between HIV and fertility or fertility desire were found in 2005.

Conclusions
These findings suggest no difference in births or current pregnancy among HIV-seropositive and HIV-seronegative women. That in 2010 HIV-seropositive women in their earlier childbearing years desired fewer children than HIV-seronegative women could suggest more women with HIV survived; and stigma, fear of transmitting HIV, or realism about living with HIV and prematurely dying from HIV may affect their desire to have children. These findings emphasize the importance of delivering appropriate information about pregnancy and childbearing to HIV-infected women, enabling women living with HIV to make informed decisions about their reproductive life.
1742-4755
Remera, Eric
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Boer, Kimberly
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Umuhoza, Stella M.
a38d5ae9-6543-4818-ba12-38f8c74a6136
Hedt-Gauthier, Bethany L.
636801e6-cff6-41a0-8cff-69d988728a91
Thomson, Dana, Renee
c6aa22a0-9ee2-4d86-9bd4-b3a8487eb15b
Ndimubanzi, Patrick
dea6de1a-b8e9-4340-b329-d09e314cbd70
Kayirangwa, Eugenie
d10d4ca5-7f50-439a-b1e9-a23fe7f7c932
Mutsinzi, Salomon
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Bayingana, Alice
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Mugwaneza, Placidie
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Koama, Jean Baptiste T.
4dcfe1ed-2965-4950-a146-8e9795399815
Remera, Eric
4a6b8ef1-122c-493e-83c4-6c6a79bbafd9
Boer, Kimberly
74b04d4d-f21c-48ab-88b0-ecc0b23a439f
Umuhoza, Stella M.
a38d5ae9-6543-4818-ba12-38f8c74a6136
Hedt-Gauthier, Bethany L.
636801e6-cff6-41a0-8cff-69d988728a91
Thomson, Dana, Renee
c6aa22a0-9ee2-4d86-9bd4-b3a8487eb15b
Ndimubanzi, Patrick
dea6de1a-b8e9-4340-b329-d09e314cbd70
Kayirangwa, Eugenie
d10d4ca5-7f50-439a-b1e9-a23fe7f7c932
Mutsinzi, Salomon
3b0db250-597c-4fcd-9395-1e8cd436962d
Bayingana, Alice
69b25fed-750b-4de7-9f58-a50102e78b2c
Mugwaneza, Placidie
731f970e-29d0-4c9f-a1e2-ce2c0a6c3564
Koama, Jean Baptiste T.
4dcfe1ed-2965-4950-a146-8e9795399815

Remera, Eric, Boer, Kimberly, Umuhoza, Stella M., Hedt-Gauthier, Bethany L., Thomson, Dana, Renee, Ndimubanzi, Patrick, Kayirangwa, Eugenie, Mutsinzi, Salomon, Bayingana, Alice, Mugwaneza, Placidie and Koama, Jean Baptiste T. (2017) Fertility and HIV following universal access to ART in Rwanda: a cross-sectional analysis of Demographic and Health Survey data. Reproductive Health. (doi:10.1186/s12978-017-0301-x).

Record type: Article

Abstract

Background
HIV infection is linked to decreased fertility and fertility desires in sub-Saharan Africa due to biological and social factors. We investigate the relationship between HIV infection and fertility or fertility desires in the context of universal access to antiretroviral therapy introduced in 2004 in Rwanda.

Methods
We used data from 3532 and 4527 women aged 20–49 from the 2005 and 2010 Rwandan Demographic and Health Surveys (RDHS), respectively. The RDHSs included blood-tests for HIV, as well as detailed interviews about fertility, demographic and behavioral outcomes. In both years, multiple logistic regression was used to assess the association between HIV and fertility outcomes within three age categories (20–29, 30–39 and 40–49 years), controlling for confounders and compensating for the complex survey design.

Results
In 2010, we did not find a difference in the odds of pregnancy in the last 5 years between HIV-seropositive and HIV-seronegative women after controlling for potential biological and social confounders. Controlling for the same confounders, we found that HIV-seropositive women under age 40 were less likely to desire more children compared to HIV-seronegative women (20–29 years adjusted odds ratio (AOR) = 0.31, 95% CI: 0.17, 0.58; 30–39 years AOR = 0.24, 95% CI: 0.14, 0.43), but no difference was found among women aged 40 or older. No associations between HIV and fertility or fertility desire were found in 2005.

Conclusions
These findings suggest no difference in births or current pregnancy among HIV-seropositive and HIV-seronegative women. That in 2010 HIV-seropositive women in their earlier childbearing years desired fewer children than HIV-seronegative women could suggest more women with HIV survived; and stigma, fear of transmitting HIV, or realism about living with HIV and prematurely dying from HIV may affect their desire to have children. These findings emphasize the importance of delivering appropriate information about pregnancy and childbearing to HIV-infected women, enabling women living with HIV to make informed decisions about their reproductive life.

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More information

Accepted/In Press date: 6 March 2017
e-pub ahead of print date: 14 March 2017
Published date: 14 March 2017

Identifiers

Local EPrints ID: 415369
URI: http://eprints.soton.ac.uk/id/eprint/415369
ISSN: 1742-4755
PURE UUID: 0e61168c-f0cc-4df6-8f13-0bb84bf09979
ORCID for Dana, Renee Thomson: ORCID iD orcid.org/0000-0002-9507-9123

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Date deposited: 08 Nov 2017 17:30
Last modified: 15 Mar 2024 16:41

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Contributors

Author: Eric Remera
Author: Kimberly Boer
Author: Stella M. Umuhoza
Author: Bethany L. Hedt-Gauthier
Author: Dana, Renee Thomson ORCID iD
Author: Patrick Ndimubanzi
Author: Eugenie Kayirangwa
Author: Salomon Mutsinzi
Author: Alice Bayingana
Author: Placidie Mugwaneza
Author: Jean Baptiste T. Koama

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