Childbearing intentions of HIV-positive women of reproductive age in Soweto, South Africa: the influence of expanding access to HAART in an HIV hyperendemic setting

Abstract

Objectives: We investigated whether the intention to have children varied according to HIV status and use of highly active antiretroviral therapy (HAART) among women in Soweto, South Africa.

Methods: We used survey data from 674 women aged 18 to 44 years recruited from the Perinatal HIV Research Unit in Soweto (May through December 2007); 217 were HIV-positive HAART users (median duration of use = 31 months; interquartile range = 28, 33), 215 were HIV-positive and HAART-naive, and 242 were HIV negative. Logistic regression models examined associations between HIV status, HAART use, and intention to have children.

Results: Overall, 44% of women reported intent to have children, with significant variation by HIV status: 31% of HAART users, 29% of HAART-naive women, and 68% of HIV-negative women (P < .001). In adjusted models, HIV-positive women were nearly 60% less likely to report childbearing intentions compared with HIV-negative women (for HAART users, adjusted odds ratio [AOR] = 0.40; 95% confidence interval [CI] = 0.23, 0.69; for HAART-naive women, AOR = 0.35; 95% CI = 0.21, 0.60), with minimal differences according to use or duration of HAART.

Conclusions: Integrated HIV, HAART, and reproductive health services must be provided to support the rights of all women to safely achieve their fertility goals.

FIGURE 1—

Percentage of HIV-positive women who intend to have (more) children, by length of time on highly active antiretroviral therapy (HAART): Soweto, South Africa, 2007. Note. Women (n = 432) were aged 18 to 44 years and nonsterilized. Bars represent standard errors.