Research Article: Fertility Desires and Intentions of HIV-Positive Women of Reproductive Age in Ontario, Canada: A Cross-Sectional Study

Date Published: December 7, 2009

Publisher: Public Library of Science

Author(s): Mona R. Loutfy, Trevor A. Hart, Saira S. Mohammed, DeSheng Su, Edward D. Ralph, Sharon L. Walmsley, Lena C. Soje, Marvelous Muchenje, Anita R. Rachlis, Fiona M. Smaill, Jonathan B. Angel, Janet M. Raboud, Michael S. Silverman, Wangari E. Tharao, Kevin Gough, Mark H. Yudin, Landon Myer.

Abstract: Improvements in life expectancy and quality of life for HIV-positive women coupled with reduced vertical transmission will likely lead numerous HIV-positive women to consider becoming pregnant. In order to clarify the demand, and aid with appropriate health services planning for this population, our study aims to assess the fertility desires and intentions of HIV-positive women of reproductive age living in Ontario, Canada.

Partial Text: Indisputable health improvements have occurred with the advent of antiretroviral therapy (ART) over the last 15 years, resulting in dramatic reductions in HIV-related morbidity and mortality and yielded improvements in quality of life [1]. Breakthroughs in pregnancy care have reduced the risk of vertical transmission to <1% if pregnant women receive timely ART, achieve optimal viral suppression, deliver by caesarean-section when appropriate, and avoid breastfeeding [2]. Over the past several years, the worldwide HIV epidemic has reached gender parity, and in parallel, the Canadian demographics have shifted towards increased rates of females being infected [3], [4]. Twenty-eight percent of all new HIV infections in Canada are diagnosed in women, who now represent 17% of Canada's HIV-positive population [4]. Furthermore, over 80% of HIV-positive women are of reproductive age [4]. In this cross-sectional study of 490 HIV-positive women of reproductive age living in Ontario, Canada, we found that 69% desire and 58% intend to become pregnant in the future. These proportions are higher than the previous Canadian and American reports with similar inclusion criteria of fertility intentions of 26% and 29%, respectively [11], [26]. The differences between our results and the previous Canadian study [11] conducted in the province of British Columbia likely relate to the unique epidemiology of HIV infection in that province, where the population includes a significant number of drug users (64%), high rates of hepatitis C co-infection (65%) and a high proportion of women who identify as Aboriginal (43%); all variables which were associated with lower fertility intentions in our study. The previous American study [26] was carried out in a population enrolled in 1996 and with a second follow-up in 1997 and 1998, a period prior to the wide use and successes of ART, likely accounting for much of the discrepancy. Furthermore, the demographic characteristics of the HIV-positive women in the United States differ from Canada with fewer immigrants and more African Americans and Latinas being affected than in Canada. Our proportions are very similar to reports of fertility desires and intentions reported in African studies. In a Nigerian study, the researchers found that 68% and 65.5% of HIV-positive women desired and intended to have children [18]. This could relate to the fact that many HIV-positive women living in Ontario, Canada were born in Africa and have sought refugee status in or immigrated to Canada (47% identified as African ethnicity). Finally, in a study of the general Canadian female population, 37.5% reported intention of pregnancy [42]. The higher proportions in our study may reflect our focus on women of reproductive age and ethnicity differences between the two populations. Source:


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