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
- 1.5k Downloads
Tailoring sexual and reproductive health services to meet the needs of people living with the human immuno-deficiency virus (HIV) is a growing concern but there are few insights into these issues where HIV is most prevalent. This cross-sectional study investigated the fertility intentions and associated health care needs of 459 women and men, not sampled as intimate partners of each other, living with HIV in Cape Town, South Africa. An almost equal proportion of women (55%) and men (43%) living with HIV, reported not intending to have children as were open to the possibility of having children (45 and 57%, respectively). Overall, greater intentions to have children were associated with being male, having fewer children, living in an informal settlement and use of antiretroviral therapy. There were important gender differences in the determinants of future childbearing intentions, with being on HAART strongly associated with women’s fertility intentions. Gender differences were also apparent in participants’ key reasons for wanting children. A minority of participants had discussed their reproductive intentions and related issues with HIV health care providers. There is an urgent need for intervention models to integrate HIV care with sexual and reproduction health counseling and services that account for the diverse reproductive needs of these populations.
KeywordsHIV Reproductive intentions Influencing factors HAART South Africa
This study was funded by the UNDP/UNFPA/WHO/World Bank Special Programme in Human Reproduction, World Health Organization (grant number A45100), the South African Medical Research Council and the University of Cape Town. We are grateful to the field staff, Nthuthu Manjezi and Pumeza Ngubane and to Penny Mgwigwi for data entry; to the Western Cape Provincial and City of Cape Town Health Departments; the health services where the study was conducted and participants. Our thanks to study consultants, Professors Zena Stein and Lesley Doyal and Dr Joanne Mantell as well as to Maria de Bruyn (Ipas, North Carolina) for insights on the subject and comments on the study instrument.
- Berer, M. (1999). HIV/AIDS, pregnancy and maternal mortality and morbidity: Implications for care. In M. Berer & T. K. Sundari Ravindran (Eds.), Safe motherhood initiatives: Critical issue (pp. 198–210). London: Blackwell Science Limited for Reproductive Health Matters.Google Scholar
- Bray, R. (2003). ‘Predicting the social consequences of orphanhood in South Africa’. CSSR Working Paper No. 29. Centre for Social Science Research. Cape Town: University of Cape Town.Google Scholar
- de Bruyn, M. (2005). Reproductive rights for women affected by HIV/AIDS. A project to monitor Millenium Development Goals 5 and 6. Chapel Hill, NC: Ipas.Google Scholar
- Department of Health. (2006). Republic of South Africa, summary report. National HIV and syphilis antenatal seroprevalence survey in South Africa. Pretoria: Government of the Republic of South Africa. Retrieved 1 October 2006 from: http:/www.health.gov.za.
- Dyer, S. J., Abrahams, N., Mokoena, N. E., & van der Spuy, Z. M. (2004). You are a man because you have children’: Experiences, reproductive health knowledge and treatment seeking behaviour among men suffering from couple infertility in South Africa. Human Reproduction, 19(4), 960.PubMedCrossRefGoogle Scholar
- Kirshenbaum, S. B., Hirky, A. E., Correale, J., Goldstein, R. B., Johnson, M. O., Rotheram-Borus, M. J., et al. (2004). ‘Throwing the dice’: Pregnancy decision-making among HIV-positive women in four US cities. Perspectives on Sexual and Reproductive Health, 36(3), 106–112.PubMedCrossRefGoogle Scholar
- Nebie, Y., Meda, N., Leroy, V., Mandelbrot, L., Yaro, S., Sombie, I., et al. (2001). Sexual and reproductive life of women informed of their HIV seropositivity: A prospective cohort study in Bukino Faso. Journal of Acquired Immune Deficiency Syndrome, 28(4), 367–372.Google Scholar
- Orner, P., Cooper, D., Myer, L., Zweigenthal, V., Bekker, L.G., & Moodley, J. (2008). Clients’ perspectives on HIV/AIDS care and treatment and reproductive health services in South Africa. AIDS Care, doi: 10.1080/09540120701867008.
- Paiva, V., Latorre, M. R., Gravator, N., & Lacerda, R. (2002). Sexuality of women living with HIV in Sao Paulo. Cadernos de Saude Publica, 18, 109–118.Google Scholar
- UNAIDS. (2008). 2008 Report on the Global AIDS Epidemic. Geneva: Joint UN Program on HIV/AIDS (UNAIDS). Available at: http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp.
- WHO. (2006). Reproductive choices and family planning for people living with HIV. Geneva: World Health Organization.Google Scholar
- Williams, C. D., Finnerty, J. J., Newberry, R. N., West, R. W., Thomas, T. S., & Pinkerton, J. V. (2003). Reproduction in couples who are affected by human immunodeficiency virus: Medical, ethical and legal considerations. American Journal of Obstetrics and Gynecology, 189(2), 333–341.PubMedCrossRefGoogle Scholar