Factors Influencing Pregnancy Desires among HIV Positive Women in Gert Sibande District in Mpumalanga, South Africa*

Article excerpt

Fertility issues for HIV-positive women are becoming increasingly important. The study investigated the pregnancy desires of HIV positive women of Gert Sibande District in Mpumalanga, South Africa. The objective of the study is to present findings on factors influencing pregnancy desires amongst HIV positive women that have participated in Prevention of Mother to child Transmission of HIV programme. A cross sectional survey was conducted. 47 public health facilities in Gert Sibande District of Mpumalanga, South Africa were used to conduct interviews between September 2008 and March 2009. 815 HIV infected mothers at postnatal care, with babies aged 3-6 months. Women in the current study had poor knowledge about HIV transmission from mother to child. We found that only 16.6% had a desire to have children. In multivariable regression analysis the desire to have children was associated with having fewer children, had discussed family planning, current partner knew his HIV status and unknown HIV status of their infant. The main family methods currently used was injection (54.8%), followed by condom (33.9%), the pill (22%) and female condom (14.6%). Women with HIV who desire to have children face risks that need special consideration. Family planning for HIV infected women should be promoted and improved in postnatal care.

Key words: Prevention of Mother to child Transmission of HIV programme (PMTCT), pregnancy desires, family planning, male involvement, HIV knowledge, HIV positive mothers.

INTRODUCTION

In sub-Saharan Africa, HIV continues to be one of the primary health issues of our time, especially among women and children. For example, in South Africa, HIV prevalence among antenatal women is 28% (NDOH, 2008). HIV affects, or potentially affects, all the dimensions of women's sexual and reproductive health i.e. pregnancy, childbirth, breastfeeding, abortion, use of contraception, exposure to, diagnosis and treatment of Sexually Transmitted Infections (STIs) and their exposure to sexual violence. For instance, HIV infection accelerates the natural history of some reproductive illnesses and increases the severity of others (WHO, 2006). Unintended pregnancy is an important public health concern in developing countries because of its association with adverse personal, economic, social and health outcomes, for both mothers and children (Eggleton, 1999; Trussell et al., 1995). These include the higher likelihood of unsafe abortion, of late initiation and underutilization of prenatal care and of low birth weight (Bitto et al., 2007).

In the last two decades, there has been an increasing interest in the reproductive and sexual behaviour of people living with HIV/ AIDS and the implications for mother to child and sexual transmission of HIV. While there is increasing awareness about the importance of family planning and HIV integration, data about family planning from PMTCT clients is lacking (Baek & Rutenberg, 2005). The effect of an HIV diagnosis on reproduction planning in developing countries is not well understood (Forsyth et al., 2002).

Concern has been expressed about the fertility of people infected with HIV: the worry has been that on learning of their condition, HIV-affected individuals may attempt to accomplish unmet reproductive goals knowing that they will not live a normal life span (Setel, 1995). Further, while the awareness of AIDS has brought about changes in some aspects of sexual life, AIDS may not be substantially influencing choices about reproduction in most contexts (Setel, 1995).

Studying fertility desires and intentions directly is essential to focus on the subset of HIV-infected women who are most likely to become pregnant by choice. The desire of HIV-infected persons to have children in the future has significant implications for the transmission of HIV to sexual partners and newborns. Although the risk of transmission of HIV from mother to infant can be decreased with prophylactic treatment, maternal transmission accounts for almost all new HIV infections in children (Lindegren et al. …