Effect of Anteritroviral Therapy(ART) on Fertility Intentions and Contraceptive Prefernce of HIV Positive Women in Addis Ababa, Ethiopia
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Date
2015-05
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Addis Ababa University
Abstract
Background: The advent of antiretroviral therapy (ART) has improved quality of life and
survival for people living with HIV (PLWH) and now days HIV infection can be seen as a
chronic manageable disease, as a result many will contemplate child bearing. Although, ART
has influence in improving quality of life and reduce mother to child transmission of HIV virus
(MTCT) in developed countries, vertical transmission accounts for more than 90% of pediatric
AIDS in prevalent areas, as a result, reproductive assistance to HIV positive women is
important to have informed decision making about child bearing and child rearing.
In Ethiopia, while anti-retroviral therapy (ART) services are increasingly available, information
about fertility intentions, contraceptive use and method preference among women living with
HIV in relation to ART use is scarce. Moreover, change in fertility intentions 12 months after
ART intiation and reasons in selection of those options are lacking. Those factors raise concern
on possible exposure of many HIV positive women to the potential risk of unintended pregnancy
and hinder them from seeking options.
Objectives: the purpose of the study was to assess effect of ART on the fertility intentions and
contraceptive use and method preference of HIV positive women in Addis Ababa, Ethiopia.
Methodology: Health facility based cross sectional quantitative and qualitative studies including
follow up studies were conducted. For the quantitative part, a total of 1855 HIV positive women
aged 15-49 years for cross sectional survey and 360 HIV positive women participated for the
follow up study. Focus group discussion, in depth interviews and key informant interviews were
done for the qualitative part. Data were collected from June 2012 to December 2013 using
validated structured questionnaires for quantitative and semi structured questionnaires for
qualitative part. Data were double entered in to epidemiological software (Epi Info version
3.5.1). Descriptive statistics, bivareate and multivariate statistical analysis were done using SPSS
version 20 soft ware.
Results: Overall, 44% of women reported childbearing intention and 71% women reported
using contraception 75% (n=579) ART users and 65% (n=422) ART naïve women. Male
condom and injectables were the most preferred contraceptive methods among both groups. The
proportion of fertility intention 12 months after antiretroviral therapy (ART) initiation was higher
among ART initiated 55.5% (n=106) than ART naïve 40% (n=68) women. The presence of
ART, improvement of health condition and the influence of husband, family, community and
associated stigma were the main reasons for childbearing intentions of women in the study area.
In adjusted logistic regression analysis, ART users had higher fertility intention (AOR; 1.26,
95%CI; 1.01 to 1.60) than ART naïve. Furthermore, being in a sexual relationship, young age,
being single and having fewer or no children were found to be predictors of fertility intentions.
Women receiving ART reported more use of contraceptives (AOR 1.60, 95% CI, 1.30- 2.12)
than ART naïve women. In addition to this, presence of partner (AOR 2.32, 95% CI, 1.60-3.40),
disclosure of HIV status to husband (AOR 2.23, 95 % CI, 1.21-4.12), presence of living
children: one (AOR 1.7, 95% C I, 1.03-2.40), two (AOR 2.6, 95% CI, 1.7-4.02) and three (AOR
3.3, 95% CI, 1.90-5.60) respectively were found to be predictors of contraceptive use among
HIV positive women.
Overall, 41.0 % (147/360) of the women reported fertility intentions at the baseline, while 48.3
%( 174/360) reported fertility intentions 12 months after follow up. The proportion of fertility
intention 12 months after antiretroviral therapy (ART) initiation was higher among ART initiated
55.8% (106/190) than HAART naïve 40% (68/170) women. Furthermore, the need for more
children 12 months after ART initiation was significantly associated with woman’s ART use
(AOR, 2.46, 95%CI, 1.20-5.20). Single and married women (AOR, 5.32, 95%CI, 1.10-25.92)
(AOR: 6.34, 95%CI, 1.43-27.99) respectively, were more likely to report fertility intention than
divorced/ widowed women. Women who had at least one child (AOR, 0.32, 95% CI, 0.13-0.85)
were less likely to change fertility intentions compared to women with no children.
Conclusions: Fertility intentions are common among HIV positive women and change in
intention for a child starts soon after initiation of ART. About three in four HIV positive women
use contraceptive methods mainly condoms. Dual contraceptive method use was negligible
among the study subjects.
Fertility and contraceptive decisions of women are influenced by presence of ART, partner
desire, family and community perception and associated stigma. Many participants indicated
that health service providers are supportive in offering information more on preventive methods
rather than discussing fertility and contraceptive options.
Recommendations: It is necessary to strengthen an integrated sexual and reproductive health
(SRH) service and HIV prevention, ART services to address the diverse SRH needs of HIV
positive women in the study area. Furthermore, updating health care providers with fertility and
contraceptive knowledge is valuable to enhance family planning and preventive practice of
women.
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Keywords
Fertility intention, contraceptive use, method preference, HIV, ART, women, Addis Ababa, Ethiopia.