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Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Fertility desire and intention of people living with HIV/AIDS in Tanzania: a call for restructuring care and treatment services

Authors: Elia J Mmbaga, Germana H Leyna, Mangi J Ezekiel, Deodatus C Kakoko

Published in: BMC Public Health | Issue 1/2013

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Abstract

Background

Scaling up of antiretroviral therapy (ART) is currently underway in sub-Saharan Africa including, Tanzania, increasing survival of people living with HIV/AIDS (PLWHA). Programmes pay little attention to PLWHA’s reproductive health needs. Information on fertility desire and intention would assist in the integration of sexual and reproductive health in routine care and treatment clinics.

Methods

A cross-sectional study of all PLWHA aged 15–49 residing in Kahe ward in rural Kilimanjaro Tanzania was conducted. Participants were recruited from the community and a local counselling centre located in the ward. Data on socio-demographic, medical and reproductive characteristics were collected through face-to-face interviews. Data were entered and analysed using STATA statistical software.

Results

A total of 410 PLWHA with a mean age of 34.2 and constituting 264 (64.4%) females participated. Fifty-one per cent reported to be married/cohabiting, 73.9% lived with their partners and 60.5% were sexually active. The rate of unprotected sex was 69.0% with 12.5% of women reporting to be pregnant at the time of the survey. Further biological children were desired by 37.1% of the participants and lifetime fertility intention was 2.4 children. Increased fertility desire was associated with living and having sex with a partner, HIV disclosure, good perceived health status and CD4 count ≥200 cells for both sexes. Reduced desire was associated with havingmore than 2 children among females, divorce or separation, and having a child with the current partner among both males and females.

Conclusion

Fertility desire and intention of PLWHA was substantially high though lower than that of the general population in Tanzania. Practice of unprotected sexual intercourse with higher pregnancy rate was observed. Fertility desire was determined by individual perceived health and socio-family related factors. With increasing ART coverage and subsequent improved quality of life of PLWHA, these findings underscore the importance of integrating reproductive health services in the routine care and treatment of HIV/AIDS worldwide. The results also highlight a group of PLWHA with potentially high desire for children who need to be targeted during care.
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Literature
1.
go back to reference UNAIDS: AIDS Epidemic update. United Nation Joint Programme on HIV/AIDS. 2011, Geneva, Switzerland: WHO/UNAIDS UNAIDS: AIDS Epidemic update. United Nation Joint Programme on HIV/AIDS. 2011, Geneva, Switzerland: WHO/UNAIDS
2.
go back to reference NBS: Tanzania Malaria and HIV/AIDS Indicator Survey 2007/2008. ICF Macro/TACAIDS. 2009, Tanzania: National Bureau of Statistics NBS: Tanzania Malaria and HIV/AIDS Indicator Survey 2007/2008. ICF Macro/TACAIDS. 2009, Tanzania: National Bureau of Statistics
3.
go back to reference Moore ALSC, Johnson MA, et al: Gender and clinical outcomes after starting highly active antiretroviral treatment: a cohort study. J Aquir Immune Defic Syndr. 2002, 29: 197-202.CrossRef Moore ALSC, Johnson MA, et al: Gender and clinical outcomes after starting highly active antiretroviral treatment: a cohort study. J Aquir Immune Defic Syndr. 2002, 29: 197-202.CrossRef
4.
go back to reference Gange SJ: "Effectiveness of highly active antiretroviral therapy among HIV-1 infected women,". J Epidemiol Commun Health. 2002, 56: 153-159. 10.1136/jech.56.2.153.CrossRef Gange SJ: "Effectiveness of highly active antiretroviral therapy among HIV-1 infected women,". J Epidemiol Commun Health. 2002, 56: 153-159. 10.1136/jech.56.2.153.CrossRef
5.
go back to reference Hogg RS YB, Kully C, et al: Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. Can Med Assoc J. 1999, 160: 659-665. Hogg RS YB, Kully C, et al: Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. Can Med Assoc J. 1999, 160: 659-665.
6.
go back to reference Nattabi BLJ, Thompson SC, Orach CG, Earnest J: A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav. 2009, 13 (5): 949-968. 10.1007/s10461-009-9537-y.CrossRefPubMed Nattabi BLJ, Thompson SC, Orach CG, Earnest J: A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav. 2009, 13 (5): 949-968. 10.1007/s10461-009-9537-y.CrossRefPubMed
7.
go back to reference TE Wilson GR, et al: Changes in sexual behaviours among HIV-infected women after initiation of HAART. Am J Public Health. 2004, 94: 1141-1146. 10.2105/AJPH.94.7.1141.CrossRef TE Wilson GR, et al: Changes in sexual behaviours among HIV-infected women after initiation of HAART. Am J Public Health. 2004, 94: 1141-1146. 10.2105/AJPH.94.7.1141.CrossRef
8.
go back to reference Cooper DHJ, Myer L, Orner P, Bracken H, Zweigenthal V: "Life is still going on": reproductive intentions among HIV-positive women and men in South Africa. Soc Sci Med. 2007, 65: 274-283. 10.1016/j.socscimed.2007.03.019.CrossRefPubMed Cooper DHJ, Myer L, Orner P, Bracken H, Zweigenthal V: "Life is still going on": reproductive intentions among HIV-positive women and men in South Africa. Soc Sci Med. 2007, 65: 274-283. 10.1016/j.socscimed.2007.03.019.CrossRefPubMed
9.
go back to reference Ogilvie GS: Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada. AIDS. 2007, 21 (Suppl 1): S83-S88. 10.1097/01.aids.0000255090.51921.60.CrossRefPubMed Ogilvie GS: Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada. AIDS. 2007, 21 (Suppl 1): S83-S88. 10.1097/01.aids.0000255090.51921.60.CrossRefPubMed
10.
go back to reference Chen JLPKA, Kanouse DE, Collins RL, Miu A: Fertility desires and intentions of HIV-positive Men and Women. Fam Plann Perspect. 2001, 33 (4): 144-152. 10.2307/2673717.CrossRefPubMed Chen JLPKA, Kanouse DE, Collins RL, Miu A: Fertility desires and intentions of HIV-positive Men and Women. Fam Plann Perspect. 2001, 33 (4): 144-152. 10.2307/2673717.CrossRefPubMed
11.
go back to reference Myer LRK, Morroni C: Missed opportunities to address reproductive health care needs among HIV-infected women in Antiretroviral Therapy Programmes. Trop Med Int Health. 2007, 12: 1484-1489. 10.1111/j.1365-3156.2007.01955.x.CrossRefPubMed Myer LRK, Morroni C: Missed opportunities to address reproductive health care needs among HIV-infected women in Antiretroviral Therapy Programmes. Trop Med Int Health. 2007, 12: 1484-1489. 10.1111/j.1365-3156.2007.01955.x.CrossRefPubMed
12.
go back to reference Kline A, SJaK J: Factors associated with pregnancy and pregnancy resolution in HIV seropositive women. Soc Sci Med. 1995, 40: 1539-1547. 10.1016/0277-9536(94)00280-7.CrossRefPubMed Kline A, SJaK J: Factors associated with pregnancy and pregnancy resolution in HIV seropositive women. Soc Sci Med. 1995, 40: 1539-1547. 10.1016/0277-9536(94)00280-7.CrossRefPubMed
13.
go back to reference Dyer SJ AN, Hoffman M, et al: Men leave me as I cannot have children".Women’s experiences with involuntary chidlessness. Human Reprod. 2002, 17: 1663-1668. 10.1093/humrep/17.6.1663.CrossRef Dyer SJ AN, Hoffman M, et al: Men leave me as I cannot have children".Women’s experiences with involuntary chidlessness. Human Reprod. 2002, 17: 1663-1668. 10.1093/humrep/17.6.1663.CrossRef
14.
go back to reference Mmbaga EJHA, Leyna GH, Mnyika KS, Sam NE, Klepp KI: Prevalence and risk factors for HIV-1 infection in rural Kilimanjaro region of Tanzania: implications for prevention and treatment. BMC Public Health. 2007, 7: 58-10.1186/1471-2458-7-58.CrossRefPubMedPubMedCentral Mmbaga EJHA, Leyna GH, Mnyika KS, Sam NE, Klepp KI: Prevalence and risk factors for HIV-1 infection in rural Kilimanjaro region of Tanzania: implications for prevention and treatment. BMC Public Health. 2007, 7: 58-10.1186/1471-2458-7-58.CrossRefPubMedPubMedCentral
15.
go back to reference Mmbaga EJHA, Leyna GH, Klouman E, Masenga E, Sam N, Mnyika KS, Klepp KI: Incidence of HIV-1 infection and changes in the prevalence of reproductive tract infections and sexual risk behaviors: a population- based longitudinal study in rural Tanzania. Afr J AIDS Res. 2006, 5 (3): 281-288. 10.2989/16085900609490390.CrossRefPubMed Mmbaga EJHA, Leyna GH, Klouman E, Masenga E, Sam N, Mnyika KS, Klepp KI: Incidence of HIV-1 infection and changes in the prevalence of reproductive tract infections and sexual risk behaviors: a population- based longitudinal study in rural Tanzania. Afr J AIDS Res. 2006, 5 (3): 281-288. 10.2989/16085900609490390.CrossRefPubMed
17.
go back to reference Myer LMC, Rebe K: Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDS. 2007, 21 (4): 278-285. 10.1089/apc.2006.0108.CrossRefPubMed Myer LMC, Rebe K: Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDS. 2007, 21 (4): 278-285. 10.1089/apc.2006.0108.CrossRefPubMed
18.
go back to reference NBS: Tanzania Demographic and Health Survey. ICF Macro. 2010, Tanzania: National Bureau of Statistics NBS: Tanzania Demographic and Health Survey. ICF Macro. 2010, Tanzania: National Bureau of Statistics
19.
go back to reference LA Oliveira FJ: Reproductive demands and health care for people living with HIV/AIDS: limits and possibilities within the context of specialized health services. Cad Saude Publica. 2003, 19: 315-323.CrossRef LA Oliveira FJ: Reproductive demands and health care for people living with HIV/AIDS: limits and possibilities within the context of specialized health services. Cad Saude Publica. 2003, 19: 315-323.CrossRef
20.
go back to reference Sarna ALS, Geibel S, Kaai S, Munyao P, Shikely KS, Mandaliya K, van Dam J, Temmerman M: Sexual risk behaviour and HAART: a comparative study of HIV-infected persons on HAART and on preventive therapy in Kenya. Int J STD AIDS. 2008, 19 (2): 85-89. 10.1258/ijsa.2007.007097.CrossRefPubMed Sarna ALS, Geibel S, Kaai S, Munyao P, Shikely KS, Mandaliya K, van Dam J, Temmerman M: Sexual risk behaviour and HAART: a comparative study of HIV-infected persons on HAART and on preventive therapy in Kenya. Int J STD AIDS. 2008, 19 (2): 85-89. 10.1258/ijsa.2007.007097.CrossRefPubMed
21.
go back to reference Kaida ALF, Strathdu SA, Janssen PA, Money D, Hogg RS, Gray G: Childbearing intentions of HIV positive women of reproductive age in Soweto, South Africa: The influence of Expanding Access to HAART in an Hyperendemic setting. Am J Public Health. 2009, 101 (2): 350-358.CrossRef Kaida ALF, Strathdu SA, Janssen PA, Money D, Hogg RS, Gray G: Childbearing intentions of HIV positive women of reproductive age in Soweto, South Africa: The influence of Expanding Access to HAART in an Hyperendemic setting. Am J Public Health. 2009, 101 (2): 350-358.CrossRef
22.
go back to reference Cooper DMJ, Zweigenthal G, Bekker LG, Shah I, Myer L: Fertility intentions and reproductive health care needs of people living with HIV in cape town, South Africa: Implications for intergrating reproductive health and HIV care services. AIDS Behav. 2009, 38-45. Suppl 1 Cooper DMJ, Zweigenthal G, Bekker LG, Shah I, Myer L: Fertility intentions and reproductive health care needs of people living with HIV in cape town, South Africa: Implications for intergrating reproductive health and HIV care services. AIDS Behav. 2009, 38-45. Suppl 1
23.
go back to reference Oladapo OTDO, Odusoga OL, et al: Fertility desires and intentions of HIV-positive patients at a suburban specialist center. J Natl Med Assoc. 2005, 97 (12): 1672-1681.PubMedPubMedCentral Oladapo OTDO, Odusoga OL, et al: Fertility desires and intentions of HIV-positive patients at a suburban specialist center. J Natl Med Assoc. 2005, 97 (12): 1672-1681.PubMedPubMedCentral
24.
go back to reference Nduna MFL: Women living with HIV in South Africa and their concerns about fertility. AIDS Behav. 2009, 13 (Suppl 1): 62-65.CrossRefPubMed Nduna MFL: Women living with HIV in South Africa and their concerns about fertility. AIDS Behav. 2009, 13 (Suppl 1): 62-65.CrossRefPubMed
25.
go back to reference Sunderland A: Influence of human immunodeficiency virus infection on reproductive decisions. Obstet Gynecol Clin North Am. 1990, 17: 585-594.PubMed Sunderland A: Influence of human immunodeficiency virus infection on reproductive decisions. Obstet Gynecol Clin North Am. 1990, 17: 585-594.PubMed
26.
go back to reference Sunderam SHL, Macaluso M, Vucetich A, Jamieson DJ, Osimo F, Duerr A, Semprini AE: Safe conception for HIV discordant couples through sperm-washing: experience and perceptions of patients in Milan, Italy. Reprod Health Matters. 2008, 16 (31): 211-219. 10.1016/S0968-8080(08)31342-1.CrossRefPubMed Sunderam SHL, Macaluso M, Vucetich A, Jamieson DJ, Osimo F, Duerr A, Semprini AE: Safe conception for HIV discordant couples through sperm-washing: experience and perceptions of patients in Milan, Italy. Reprod Health Matters. 2008, 16 (31): 211-219. 10.1016/S0968-8080(08)31342-1.CrossRefPubMed
27.
go back to reference Gray RHWM, Serwadda D, Sewankambo N, et al: Population-based study of fertility in women with HIV-1 infection in Uganda. Lancet. 1998, 35: 98-103.CrossRef Gray RHWM, Serwadda D, Sewankambo N, et al: Population-based study of fertility in women with HIV-1 infection in Uganda. Lancet. 1998, 35: 98-103.CrossRef
28.
go back to reference Kanniappan SJMJ, Kalyanwala S: Desire for motherhood: exploring HIV-positive women's desires, intentions and decision-making in attaining motherhood. AIDS Care. 2008, 20: 625-630. 10.1080/09540120701660361.CrossRefPubMed Kanniappan SJMJ, Kalyanwala S: Desire for motherhood: exploring HIV-positive women's desires, intentions and decision-making in attaining motherhood. AIDS Care. 2008, 20: 625-630. 10.1080/09540120701660361.CrossRefPubMed
Metadata
Title
Fertility desire and intention of people living with HIV/AIDS in Tanzania: a call for restructuring care and treatment services
Authors
Elia J Mmbaga
Germana H Leyna
Mangi J Ezekiel
Deodatus C Kakoko
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-86

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