Abstract
Background: Worldwide, due to the increased in the accessibility of antiretroviral therapy the number of people living with HIV (PLHIV) is increasing. The treatment has improved the health status and life expectancy of PLHIV making them to enjoy life similar to uninfected individuals. Even though efforts are being made directed towards expanding the service globally and in sub-Saharan Africa, but little attention is given towards the reproductive health needs of PLHIV. Now a day’s people living HIV continued to desire a child requiring a global attention. Therefore, this study was aimed to assess fertility desire and the associated factors among people living with HIV in Addis Ababa, Ethiopia, 2023/24. Method: A health facility based cross-sectional study was conducted among 602 people living with HIV in Addis Ababa, Ethiopia. A multi-stage sampling technique was used to select the study participants. Using SPSS version 27 binary and multivariable logistic regression was done to ascertain the factors associated with fertility desire with a 95% confidence interval. Results: In the past six months 83.1% of the PLHIV were sexually active. Overall, nearly half (47.25%) of the PLHIV had reported fertility desire. People living with HIV who had no child had a higher odds of fertility desire (AOR (95% C.I): 2.70 (1.71- 4.24)) than who had children. In addition to this, being single, partner fertility desire, discussion with an ART provider about sexuality, fertility desire and family planning, had faced community pressure to have a child, perceived improved health status, had an HIV negative sexual partner and HIV diagnosed before nine years were found to be predictors of fertility intentions. Conclusion: Nearly half of the PLHIV had reported fertility desire in the future where discussion about sexuality, fertility desire and family planning with ART provider had showna significant association with it. Therefore, health care providers and the concerned bodies should work together in strengthening the reproductive health needs of PLHIV along with HIV care and support so that they may decide freely and responsibly on their own reproductive health matters.
Keywords
People Living with HIV, ART, Addis Ababa, Fertility Desire
1. Background
According to the 2018 World AIDS day report; in the year 2019, 36.9 million people were living with HIVwhere about 2 million people were globally newly infected with HIV and an estimated 1.4 million of new HIV infections were from sub-Saharan Africa
| [1] | UNAIDS. World AIDS Day 20159 AIDS by the numbers 2015. Geneva: Switzerland. |
[1]
. In Ethiopia, according to the 2011 Heath and health related indicators there were more women (2.9%) living with HIV than men (1.9%)
| [2] | Ethiopian Federal Ministry of Health: Health and Health Related Indicators. Addis Ababa: EFMoH; 2011. |
[2]
. Worldwide, as of June 2020, 15.8 million people were accessing antiretroviral therapy and the number of people living with HIV (PLHIV) continued to be increasing and they are living longer, healthier lives
| [1] | UNAIDS. World AIDS Day 20159 AIDS by the numbers 2015. Geneva: Switzerland. |
[1]
. The treatment has improved the health status and life expectancy of PLHIV making them enjoy life similar to uninfected individuals
| [3] | Moore ALSC, Johnson MA, et al: Gender and clinical outcomes after starting highly active antiretroviral treatment: a cohort study. J Aquir Immune Defic Syndr 2002, 29: 197-202. |
| [4] | Gange SJ: "Effectiveness of highly active antiretroviral therapy among HIV-1 infected women,". J Epidemiol Commun Health 2002, 56: 153-159. |
| [5] | Nattabi BLJ, Thompson SC, Orach CG, Earnest J: A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav 2009, 13(5): 949-968. |
[3-5]
. Though major efforts are being made directed towards expanding access to antiretroviral therapy in sub-Saharan Africa
| [6] | United Nations General Assembly (UNGASS). Implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS: Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths. New York, USA: United Nations; 2011. p. 1-24. |
[6]
but little attention is giventowards the reproductive health needs of PLHIV
| [7] | UNAIDS: AIDS Epidemic update. InUnited Nation Joint Programme on HIV/AIDS. Geneva, Switzerland: WHO/UNAIDS; 2011. |
[7]
.
Now a day’s reproductive health matters of PLHIV is the growing issue as different studies revealed that, even after knowing their HIV positive status, many women continued to desire children
| [8] | Myer L, Morroni C, Rebe K: Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDS 2007, 21(4): 278-285. |
| [9] | Cooper D, Harries J, Myer L, Orner P, Bracken H, Zweigenthal V: “Life is still going on” Reproductive intentions among HIV-positive women and men in South Africa. Soc Sci Med 2007, 65(2): 274-283. |
| [10] | Homsy J, Bunnell R, Moore D, King R, Malamba S, Nakityo R, Glidden D, Tappero J, Mermin J: Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS One 2009, 4(1): e4149. |
[8-10]
. This implies being PLHIV didn’t affecttheirreproductive intentions negatively
| [11] | Baylies C: The impact of HIV on family size preference in Zambia. Reprod Health Matters 2000, 8: 77-86. |
| [12] | Feldman R, Matters, Maposhere C: Safer sex and reproductive choice: findings from positive women: voices and choices’ in Zimbabwe. Reprod Health Matters 2003, 11: 162-173. |
[11, 12]
, where the majority of women were intended to have more than two children
| [13] | Oladapo O, Daniel O, Odusoga O, Ayoola-Sotubo O: Fertility desires and intentions of HIV-positive patients at a suburban specialist center. J Natl Med Assoc 2005, 97(12): 1672-1681. |
| [14] | Iliyasu Z, Abubakar I, Kabir M, Babashani M, Faisal, Shuaib F, Aliy MH: Correlates of fertility intentions among HIV/AIDS patients in Northern Nigeria. Afr J Reprod Health 2009, 13(3): 71-83. |
[13, 14]
. Therefore, this has a significant implication for the transmission of HIV to sexual partners and newborn
| [15] | Laura P: High risk sexual behavior and fertility desire among hetrosexaul HIV positive patients with a sero-discordant partner two challenging issue. Swiss Med Wkly 2003, 133: 124-127. |
| [16] | Spriggs M, Charles T: Should HIV discordant couples have access to assisted reproductive technologies? J Med Ethics 2003, 29: 325-329. |
[15, 16]
.
A study done in Tanzania revealed that 60.5% of the study participants were sexually active and the rate of unprotected sex was 69.0%. During the time of the survey, 12.5% of the women were reported to be pregnant. About 37% of the study participants had fertility desire and their lifetime fertility intention was 2.4 children
| [17] | Elia J Mmbaga, Germana H Leyna, Mangi J Ezekiel, Kakoko DC. Fertility desire and intention of people living with HIV/AIDS in Tanzania: a call for restructuring care and treatment services. BMC Public Health 2013; 13: 86. |
[17]
. Since HIV diagnosis was made, in Uganda, 17.6% of PLHIV had produced a child, and 28.6% of the participants want to have a child in the near future
| [18] | Othman Kakaire, Michael O Osinde, Kaye DK. Factors that predict fertility desires for people living with HIV infection at a support and treatment centre in Kabale, Uganda. Reproductive Health 2010; 7: 27. |
[18]
. A cross-sectional study done among mutually disclosed sero-discordant couples in Uganda found that 59% of the couples had desired to have children sometime in the future
| [19] | Jolly Beyeza-Kashesya, Anna Mia Ekstrom, Frank Kaharuza, Florence Mirembe, Kulane A. My partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health 2010; 10: 247. |
[19]
. However, the fertility desire among PLHIV in Ethiopia was found to be higher than the above mentioned studies where 39.1% of HIV positive men and women
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
, 44%
| [21] | Hussen Mekonnen Asfaw, Gashe FE. Fertility intentions among HIV positive women aged 18-49 years in Addis Ababa Ethiopia: a cross sectional study. Reproductive Health 2014; 11: 36. |
[21]
and 45.5%
| [22] | Yohannes Adama Melaku, Ejigu Gebeye Zeleke, John Kinsman, Abraha AK. Fertility desire among HIV-positive women in Tigray region, Ethiopia: implications for the provision of reproductive health and prevention of mother-to-child HIV transmission services. BMC Women's Health 2014; 14: 137. |
[22]
of HIV positive women reported a desire to have children in the future.
Different studies have demonstrated the factors associated with fertility desire; a study done in Uganda found that the increased in fertility desire was significantly associated with partner’s belief to have a child irrespective of HIV sero-status. Among the couples; the woman was HIV-positive, the odds of increased fertility desire was significantly associated with young age and relatives' pressure to have a child, on the other hand, the man was HIV positive, having good knowledge about the effectiveness of ART was related tothe increased fertility desire
| [19] | Jolly Beyeza-Kashesya, Anna Mia Ekstrom, Frank Kaharuza, Florence Mirembe, Kulane A. My partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health 2010; 10: 247. |
[19]
. Furthermore, an increased in fertility desire, for both sexes, was documented among those who live with a partner and had sexual intercourse, a perceived improved health status and a CD4 count of 200 or more cells
| [17] | Elia J Mmbaga, Germana H Leyna, Mangi J Ezekiel, Kakoko DC. Fertility desire and intention of people living with HIV/AIDS in Tanzania: a call for restructuring care and treatment services. BMC Public Health 2013; 13: 86. |
[17]
.
Similarly, age, marital length, biological children, pressure from sexual partner and the community for children and duration since HIV diagnosis was made
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
, being on ART
| [21] | Hussen Mekonnen Asfaw, Gashe FE. Fertility intentions among HIV positive women aged 18-49 years in Addis Ababa Ethiopia: a cross sectional study. Reproductive Health 2014; 11: 36. |
[21]
, having a relatively few children
| [22] | Yohannes Adama Melaku, Ejigu Gebeye Zeleke, John Kinsman, Abraha AK. Fertility desire among HIV-positive women in Tigray region, Ethiopia: implications for the provision of reproductive health and prevention of mother-to-child HIV transmission services. BMC Women's Health 2014; 14: 137. |
[22]
and HIV disclosure status to husband/sexual partner
| [17] | Elia J Mmbaga, Germana H Leyna, Mangi J Ezekiel, Kakoko DC. Fertility desire and intention of people living with HIV/AIDS in Tanzania: a call for restructuring care and treatment services. BMC Public Health 2013; 13: 86. |
[17]
were significantly associated with increased fertility desire. On the contrary, to the above mentioned, having more than two children among women, divorce and separation and having a child from current sexual partner for both sexes
| [17] | Elia J Mmbaga, Germana H Leyna, Mangi J Ezekiel, Kakoko DC. Fertility desire and intention of people living with HIV/AIDS in Tanzania: a call for restructuring care and treatment services. BMC Public Health 2013; 13: 86. |
[17]
, young age, single in marital status and had lost some children
| [18] | Othman Kakaire, Michael O Osinde, Kaye DK. Factors that predict fertility desires for people living with HIV infection at a support and treatment centre in Kabale, Uganda. Reproductive Health 2010; 7: 27. |
[18]
and having information on contraception
| [19] | Jolly Beyeza-Kashesya, Anna Mia Ekstrom, Frank Kaharuza, Florence Mirembe, Kulane A. My partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health 2010; 10: 247. |
[19]
were inversely associated with fertility desire in the future.
Most of the studies done in the world as well as in Ethiopia are conducted among women living with HIV where the findings could be under and/ or overestimate fertility intention; would not reflect the approximate fertility level. Moreover, the studies done in Ethiopia are not consistent in every part of the country which could be influenced by different societal factors. Thus, this study was aimed to assess fertility desire and the factors associated with it among people living with HIV in Addis Ababa. Ethiopia.
2. Methods
Study area and period
The study was conducted in the three sub cities (Addis Ketema, and Kolfe Keranio sub city) of Addis Ababa from September to October 30, 2023. Addis Ababa is the capital city of Ethiopia, founded in 1886, is located at 9.030 North and 38.740 East. The city is subdivided into ten sub city administrations and according to the 2019 Central Statistical Agency population projection for Ethiopia, Addis Ababa has a total population of 4.35 million people in the year 2019(23).
According to the 2019 Ethiopian Demographic and Health Survey the percentage prevalence of HIV among men and women age 15-49 in Addis Ababa was 5.2%, it is the second highest prevalence in the country next to Gambella region (6.5%)(24). In the city, in the year 2019 there were five public hospitals, thirteen private hospitals, 25 health centers and one clinic proving ART service (25) and there were 124,983PLHIV enrolled in the service, 76,035 ever started and 54,667 of them were on ART(26).
In the three sub cities, there are a total of 28 governmental Health Centers; ten in Addis Ketema sub city, seven in theKirkos sub city and eleven in theKolfe Keranio sub city. However, only eleven of them are providing ART service; three in the Addis Ketema sub city, and five in the Kolfe Keranio sub city(27).
2.1. Study Design
A health facility based cross sectional study was conducted in the three sub cities of Addis Ababa. The study was conducted among PLHIV who were on ART follow up; i.e., who had at least one visit to the selected Antiretroviral (ARV) treatment units for care and follow up.In this study fertility desire was defined as ‘PLHIV who had a desire to have at least one child within or after a year’.
2.2. Sampling
A single population proportion formula was used to determine the sample size; where a 95% confidence interval, 5% margin of error, a 39.1% level of fertility desire among PLHIV in Fitche Hospital
| [23] | Central Statistical Agency, Population Projections for Ethiopia, 2007-2037. July 2013, Addis Ababa. |
[23]
, 10% non-response rate and 1.5 design effect were assumed in the determination process. Based on this assumption, finally we get a sample of 604 people living with HIV.
A multistage sampling technique was employed to select the study participants. At stage one, out of the ten sub cities in Addis Ababa, three sub cities were selected using a simple random sampling technique. Similarly, at stage two, using a simple random sampling method, from eleven health centers providing Antiretroviral Treatment (ART) and Prevention of Mother to Child Transmission of HIV (PMTCT) service six health centers were selected. Finally the study participants were selected using a systematic random sampling method with proportionate allocation to size where the sampling interval ‘K’ was determined for each health facility based on the previous six months client flow.
People living with HIV, those in a reproductive age group (18-49 for women and 18-60 for men) and had at least one visit to the selected health centers ARV treatment units were included in this study.The lower age cut point was based on the 2000 the revised family code proclamation of Ethiopia “Article 31: Age without prejudice to Sub-Article (2) of Article 7 of this Code, marriage concluded by a man or a woman under the age of eighteen years shall dissolve on the application of any interested person or the public prosecutor”(28). On the other hand, all PLHIV who were unable to hear, mentally disabled, and seriously ill were excluded from the study.
2.3. Data Collection
An interview administered structured pre-tested close-ended questionnaire was used to collect the data. The questionnaire was first prepared in English and was translated into Amharic Version, which later on were translated back to the English version to check its consistency. It was mainly focused on socio-demographic variables, period of ART follow up, fertility desire, and Mother to Child Transmission of HIV/AIDS /Prevention of Mother to Child Transmission of HIV/AIDS. The data were collected after briefing the objective of the study and verbal informed consent. The data were collected by 17 data collectors (clinical nurses) and five supervisors (public health officers). It was collected in the quietest corner of the health center where there was no noise and disturbance and took an average of 40 minutes.
To assure the quality of the data, pretest was done on 5% of the sample size and two days of training was given for the data collectors and the supervisors on the objective of the study, the tool /questionnaire, the data collection procedure and the ethical procedures. The collected data were checked on a daily basis for completeness and consistency.
Data analysis
Data were coded and entered into Epidata version 3.1 and were exported to SPSS version 20.0 for analysis. Descriptive frequencies were conducted to describe the study population in relation to relevant variables. Bivariate logistic regression analysis was used to assess the association between the dependent and independent variables. Finally, variables which show an association in the bivariate logistic regression and p-value less than 0.05 with 95% confidence interval were entered into the multivariable logistic regression model to identify key significant factors associated with the dependent variable (fertility desire).
2.4. Ethical Consideration
Ethical clearance was obtained from Debre Markos University, College of Medicine and Health Sciences, Research Ethics Committee. A formal letter of permission and support was obtained from the Addis Ababa Health Bureau and Sub-City Health Department to the respective Health Centers. After explaining the purpose of the study a verbal informed consent was obtained from the participants. Confidentiality of information was maintained by omitting any personal identifier from the questionnaire.
3. Results
Socio demographic characteristics of PLHIV
In this study a total of 602 PLHIV were participated obtaining a 99.67% response rate. The majority, 223 (37.04%) of them were from Kolfe Keranio sub city. Three hundred thirteen (51.99%) of them were females and 171 (28.4%) of them were above the age of 34 years with a mean age of 30.73 (±6.48) years. About half of the participants, 305 (50.7%) were Orthodox Christians and only 240 (39.9%) of them had attained secondary level of education. With regard to marital status 208 (34.6%) of them were currently married and 290 (48.2%) of them had a monthly income of 601-1000 Ethiopian Birr (
Table 1).
Table 1. Socio demographic characteristic of PLHIV on ART in Addis Ababa, Ethiopia, 2024(n = 602).
Variables | Frequency | Percentage |
Age | <= 24 Years | 116 | 19.3 |
25-29 Years | 165 | 27.4 |
30-34 Years | 150 | 24.9 |
>=35 Years | 171 | 28.4 |
Sex | Male | 289 | 48.0 |
Female | 313 | 52.0 |
Religion | Orthodox Christians | 305 | 50.7 |
Muslim | 162 | 26.9 |
Protestant | 118 | 19.6 |
Catholic | 17 | 2.8 |
Ethnicity | Amhara | 200 | 33.2 |
Oromo | 175 | 29.1 |
Tigrie | 100 | 16.6 |
Gurage | 127 | 21.1 |
Marital status | Single | 178 | 29.6 |
Married | 208 | 34.5 |
Dissolved† | 216 | 35.9 |
Educational status | Illiterate | 41 | 6.8 |
Read and write only | 31 | 5.1 |
Primary | 172 | 28.6 |
Secondary | 240 | 39.9 |
Preparatory | 82 | 13.6 |
12+ | 36 | 6.0 |
Occupational status | Housewife | 31 | 5.1 |
Daily laborer | 32 | 5.3 |
Bar worker | 65 | 10.8 |
Government employed | 129 | 21.4 |
Private employed | 321 | 53.3 |
Others†† | 24 | 4.0 |
Monthly income(Ethiopian Birr) | <=600 Birr | 72 | 12.0 |
601-1000 Birr | 290 | 48.2 |
1001-1400 Birr | 112 | 18.6 |
>=1401 Birr | 128 | 21.3 |
† (widowed/divorced), †† (student and merchant)
Sexual activity and contraceptive use
The majority of the PLHIV 500 (83.1%) were sexually active in the past six months. Of those who were sexually active in the past six months 289 (57.8%) of them were using condom, of which 204 (70.59%) used always. The main reasons mentioned for use of condom wereto prevent pregnancy 227 (78.55%), to protect a negative partner 22 (7.61%) and 40 (13.84%) of them had mentioned that they were advised by health providers. Whereas for those who had not used condom the main reasons mentioned were desired to conceive and the partner’s objection which account 143 (67.77%) and 68 (32.23%) respectively. During the survey 302 (50.2%) of them or their partners were using contraceptives; the most widely used method was pills, 257 (85.1%). The choice of the family planning method used for 153 (50.66%) of them was based on its comfort to them or their partners’ health.
More than half, 336 (55.8%) of the participants had gave birth; of these 295(87.8%) of them had one to two living children whereas the rest had three or more children. Previously, for those who gave birth, 36 (10.71%) of their children were died related to HIV/AIDS. One hundred six (17.6%) of the PLHIV had a history of at least one pregnancy or their partners were pregnant post-HIV diagnosis.
Fertility desire of PLHIV
In this study out of the 602 interviewed PLHIV 284 (47.2%) of them had fertility desire; 108 (38.0%), 129 (45.4%), and 47 (16.5%) were desired to have a child within the next 12 months, within two years and after two years respectively. Their desired number of children were one, two and three to four for the 72 (25.4%), 163 (57.4%) and 49 (17.3%) PLHIV’s respectively. With regard to the preference of the sex of a child born in the future, 125 (44.01%) didn’t prefer any sex while 83 (29.23%) of them preferred male sex.
The main reasons mentioned for their fertility desire were; 116 (40.85%) of them wanted to have at least one child to replace themselves, 139 (48.94%) did not have the desired number of children and 24 (8.45%) of them want to strength their marriage. Moreover, other PLHIV’s wanted to replacethe previous deadchild and believed that by using ART/PMTCT to get HIV free baby (perceived efficacy of PMTCT and ART). To be pregnant or their partner’s to be pregnant, 112 (39.44%) of them had taken measures; 70 (62.5%) stopped taking contraceptive methods, 24 (21.43%) of them discussed with the caregivers and 18 (16.07%) had approached their partners. On the other hand, among those who had no fertility desire, 121 (38.05%) and 116 (36.48%) of them had mentioned that their main reasons for not having a fertility desire in the futurewere child bearingwould compromise their or partner’s health and fear of MTCT respectively (
Figure 1).
Figure 1. Reasons for not having fertility desire among PLHIV on ART in Addis Ababa, Ethiopia, 2024.
Factors associated with fertility desire among PLHIV on ART in Addis Ababa
According to the multivariable analysis PLHIV who were single and had no child were 3.36 and 2.70 times more likely to have fertility desire in the future than those who had dissolved their marriage (AOR (95% C.I) 3.36 (1.96-5.73)) and had a child (AOR (95% C.I): 2.70 (1.71- 4.24)) respectively. The study participants who had discussed about sexuality, fertility desire and family planningwith ART provider were 3.18 times more likely to have a fertility desire than those who didn’t discuss (AOR(95%: CI: 3.18 (1.76- 5.77)).
People living with HIV who had faced partner and community pressure to have a child had a4.18 and 2.29 times higher odds of fertilitydesire than those who had not faced such pressure(AOR(95% CI) 4.18(2.75 - 6.36)) and(AOR(95%CI: 2.29 (1.07 - 4.89)) respectively. ThosePLHIV’s who were diagnosed before nineyears were 2.62 times more likely to desire a child than those diagnosed within three years (AOR(95%CI: 2.62(1.61 - 4.25)). Similarly, the odds of fertility desire were 2.75 times higher among those who had a perceived improved health statusthan those who had no change (AOR (95% CI: 2.75(1.71- 4.41)). Furthermore, individuals who hadan HIV negative sexual partner were 2.62 times more likely to desire children than their counterparts (AOR(95% CI: 2.62(1.61- 4.25). However, age of respondent, monthly income and who had faced family pressure to have a child were confounding variables (
Table 2).
Table 2. Factors associated with fertility desire among PLHIV in Addis Ababa, Ethiopia, 2024 (n = 602).
Variables | Fertility Desire | Crude Odds Ratio (95% C.I.) | Adjusted Odds Ratio (95% C.I.) |
Yes | No |
No (%) | No (%) |
Age | >=35 Years | 74 (43.3) | 97 (56.7) | 1.00 | 1.00 |
<= 24 Years | 73 (62.9) | 43 (37.1) | 2.23 (1.37 - 3.61)** | 1.02 (0.47 - 2.23) |
25-29 Years | 74 (44.8) | 91 (55.2) | 1.07 (0.69 - 1.64) | 1.26 (0.67 - 2.35) |
30-34 Years | 63 (42.0) | 87 (58.0) | 0.95 (0.61 - 1.48) | 1.08 (0.58 - 2.00) |
Marital status | Dissolved | 66 (30.6) | 150 (69.4) | 1.00 | 1.00 |
Single | 116 (65.2) | 62 (34.8) | 4.25 (2.79 - 6.49)*** | 3.36 (1.96 - 5.73)*** |
Married | 102 (49.0) | 106 (51.0) | 2.19 (1.47 - 3.25)*** | 1.55 (0.92 - 2.61) |
Monthly income (Ethiopian Birr) | <=600 | 40 (55.6) | 32 (44.4) | 1.00 | 1.00 |
601-1000 | 140 (48.3) | 150 (51.7) | 0.75 (0.44 - 1.25) | 0.97 (0.51 - 1.87) |
1001-1400 | 45 (40.2) | 67 (59.8) | 0.54 (0.30 - 0.98)* | 0.67 (0.32 - 1.41) |
>=1401 | 59 (46.1) | 69 (53.9) | 0.68 (0.38 - 1.22) | 0.76 (0.37 - 1.55) |
Gave birth | Yes | 124 (36.9) | 212 (63.1) | 1.00 | 1.00 |
No | 160 (60.2) | 106 (39.8) | 2.58 (1.85 - 3.59)*** | 2.70 (1.71 - 4.24)*** |
Partner fertility desire | Yes | 213 (63.6) | 122 (36.4) | 4.82 (3.39 - 6.85)*** | 4.18 (2.75 - 6.36)*** |
No | 71 (26.6) | 196 (73.4) | 1.00 | 1.00 |
Discuss with ART provider | Yes | 71 (75.5) | 23 (24.5) | 4.28 (2.59 - 7.06)*** | 3.18 (1.76 - 5.77)*** |
No | 213 (41.9) | 295 (58.1) | 1.00 | 1.00 |
Face family pressure for having children | Yes | 69 (66.3) | 35 (33.7) | 2.60 (1.67 - 4.04)*** | 1.03 (0.57 - 1.87) |
No | 215 (43.2) | 283 (56.8) | 1.00 | 1.00 |
Face community pressure for having children | Yes | 39 (73.6) | 14 (26.4) | 3.46 (1.84 - 6.51)*** | 2.29 (1.07 - 4.89)* |
No | 245 (44.6) | 304 (55.4) | 1.00 | 1.00 |
Duration since HIV Diagnosis | <=3 years | 74 (62.2) | 45 (37.8) | 1.00 | 1.00 |
4 - 6 years | 106 (46.5) | 122 (53.5) | 0.53 (0.34 - 0.83)** | 0.89 (0.51 - 1.54) |
7 - 9 years | 48 (29.8) | 113 (70.2) | 0.26 (0.16 - 0.43)*** | 0.64 (0.34 - 1.19) |
>=10 years | 56 (59.6) | 38 (40.4) | 0.90 (0.52 - 1.56) | 2.62 (1.61 - 4.25)* |
Perceived health status | No change | 50 (32.5) | 104 (67.5) | 1.00 | 1.00 |
Improving | 234 (52.2) | 214 (47.8) | 2.27 (1.55 - 3.34)*** | 2.75 (1.71 - 4.41)*** |
Partner HIV status | Positive | 202 (42.6) | 272 (57.4) | 1.00 | 1.00 |
Negative | 82 (64.1) | 46 (35.9) | 2.40 (1.60 - 3.60)*** | 2.62 (1.61 - 4.25)*** |
Significant at *p-value < 0.05, **p-value < 0.01, and ***p-value < 0.001.
4. Discussion
In this study the prevalence of fertility desire of PLHIV was 47.2%, which is higher than a study done in Fitche Hospital
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
, Addis Ababa
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
, Finoteselam Hospital
| [24] | Central Statistical Agency [Ethiopia], ICF international: Ethiopia demographic and health survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central statistical agency and ICF international; 2012. |
[24]
, Hosanna (30), and South Wollo (31). This difference might be due to the time gap; i.e., as the time goes up the opportunities and/ or accessibility of health services and their knowledge about the disease and the health services might advance. Furthermore, it could be due to the difference in the study area and the study participants where the study done in Addis Ababa was among women which could underestimate the level of fertility intention.
The odds of having fertility desire was higher among PLHIV who had no children than those who had one or more children. It is similar toother studies done in Ethiopia; Addis Ababa
, Finoteselam
| [24] | Central Statistical Agency [Ethiopia], ICF international: Ethiopia demographic and health survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central statistical agency and ICF international; 2012. |
[24]
, Fitche
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
, Tigray
| [22] | Yohannes Adama Melaku, Ejigu Gebeye Zeleke, John Kinsman, Abraha AK. Fertility desire among HIV-positive women in Tigray region, Ethiopia: implications for the provision of reproductive health and prevention of mother-to-child HIV transmission services. BMC Women's Health 2014; 14: 137. |
[22]
and Nekemte
| [26] | Federal Ministry of Health Ethiopia FMoHE: Health and Health Related Indicators. Addis Ababa: FMoHE; 2011. |
[26]
and in other African countries; Nigeria
| [27] | Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia, 2015. |
[27]
, Malawi
| [28] | Federal Negarit Gazetta of the Federal Democratic Republic of Ethiopia. The Revised Family Code. Federal Negarit Gazetta Extra Oridnary Issue No. 1/2000. The Revised Family Code Proclamation No. 213/2000. 4th Day of July, 2000. Addis Ababa, Ethiopia. |
[28]
, Uganda
| [29] | Fassika Abbawa, Worku Awoke, Alemu Y. Fertility desire and associated factors among clients on highly active antiretroviral treatment at finoteselam hospital Northwest Ethiopia: a cross sectional study. Reproductive Health 2015; 12: 69. |
| [30] | Abebe M, Addissie A, Regassa T. Fertility desire and contraceptive utilization among people living with HIV/AIDS on ART in Hosanna Town, Southern Ethiopia. Sci Technol Arts Res J. 2012; 1(4): 38-46. |
[29, 30]
and South Africa
| [31] | Getachew M, Alemseged F, Abera M, Deribew A: Factors affecting fertility decisions of married men and women living with HIV in South Wollo Zone. Northeast Ethiopia. Ethiop J Health 2010, 24(3): 214-220. |
| [32] | Tamene W, Fantahun M. Fertility desire and family-planning demand among HIV-positive women and men undergoing antiretroviral treatment in Addis Ababa, Ethiopia. African Journal of AIDS Research. 2007; 6 (3) 223-7. |
[31, 32]
. In addition to this, fertility desire was higher among single PLHIV as compared to those who had dissolved their marriage. This might be attributed by the societal belief where a child is thought as a precondition to have a joyful life; such as Ethiopia. Moreover, in some African countries like Kenya, especially among HIV positive women, having a child is considered as a means of stability of marriage/ union, meeting a desired family size, wantto have a biological child and the socio-cultural pressures were the most important reasons forced them to desire a child
| [33] | Tesfaye Regassa, Fantahun M. Fertility Desire and Reproductive Health Care Needs of Men and Women Living with HIV/AIDS in Nekemte, East Wollega, Ethiopia Sci Technol Arts Res. 2012; 1(3): 31-8. |
[33]
. Unmarried individuals might have a higher odds of fertility desire as they might be in the younger ages of their reproductive life and they might not have a child or do not achieve their desired family size too. And therefore, while providing services a special attention should be given to their sexual and reproductive health needs.
People living with HIV who had faced community pressure for having a child had a higher odds of fertility desire as comparedto their counterparts. This finding is consistent with other studies done in Ethiopia
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
, Uganda
| [34] | Iliyasu Z, Isa Abubakar MK, Musa Babashani FS, Aliyu MH: Correlates of fertility intentions among HIV/AIDS patients in northern Nigeria. Afr J Reprod Health 2009, 13(3): 71-83. |
[34]
and South Africa
| [35] | Yeatman S: The impact of HIV status and perceived status on fertility desires in rural Malawi. AIDS Behav 2009, 13: 12-19. |
[35]
. Furthermore, PLHIV whose partner had fertility desire were more likely to desire babies; this is supported by a studydone in Addis Ababa
, SouthWollo
| [36] | Kipp W, Heys J, Jhangri GS, Alibhai A, Rubaale T: Impact of antiretroviral therapy on fertility desires among HIV-infected persons in rural Uganda. Reprod Health 2011, 8(27). |
[36]
, Fitche
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
, Nekemte town
| [26] | Federal Ministry of Health Ethiopia FMoHE: Health and Health Related Indicators. Addis Ababa: FMoHE; 2011. |
[26]
, Uganda
| [19] | Jolly Beyeza-Kashesya, Anna Mia Ekstrom, Frank Kaharuza, Florence Mirembe, Kulane A. My partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health 2010; 10: 247. |
[19]
and South Africa
| [32] | Tamene W, Fantahun M. Fertility desire and family-planning demand among HIV-positive women and men undergoing antiretroviral treatment in Addis Ababa, Ethiopia. African Journal of AIDS Research. 2007; 6 (3) 223-7. |
[32]
. This is obviously true in a community or society where childbearing had social and cultural value; it is a means of maintaining identity and social status which works in most African countries. This might be due to the fact in these societies childless individual’s or couples will face social disapproval and intense pressure from family, spouse and friends too. And thus, childbearing, especially PLHIV, might re-establish a higher self-esteem and to restore a sense of normal family life and health. Moreover, family planning as well as fertility related services should not only focus on a woman, rather it should address both partners.
The odds of having fertility desire was higher among PLHIV who had a discordant sexual partner which is supported by studies done in Ethiopia; Fitche
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
, Uganda
| [30] | Abebe M, Addissie A, Regassa T. Fertility desire and contraceptive utilization among people living with HIV/AIDS on ART in Hosanna Town, Southern Ethiopia. Sci Technol Arts Res J. 2012; 1(4): 38-46. |
[30]
and BurkinaFaso
| [37] | Kakaire O, Osinde M, Kaye D: Factors that predict fertility desires for people living with HIV infection at support and treatment centre in Kabale. Uganda. Reprod Health 2010, 7(1): 27. |
[37]
. The world is full of controversies; so far the life of HIV serodiscordant couples is under this umbrella where one scarify for partner’s interestto maintain their relationship
| [30] | Abebe M, Addissie A, Regassa T. Fertility desire and contraceptive utilization among people living with HIV/AIDS on ART in Hosanna Town, Southern Ethiopia. Sci Technol Arts Res J. 2012; 1(4): 38-46. |
[30]
. Under this circumstance, couples might be forced to have a child from their beloved partner and/ or the societal norms and customs with regard to childbearing might influence them. At this point it is the responsibility of the healthcare provider to provide necessary health information; such as about fertility, vertical transmission of HIV, mother to child transmission of HIV, complications that will arise during pregnancy, etc. to make informed voluntary and responsible decisions about their reproduction.
Duration since HIV diagnosis was significantly associated as PLHIV who were diagnosed before nine years were more likely to have desire of children than those diagnosed within three years. However, this finding is in contrary to the study done in Fitche Hospital, Ethiopia
| [20] | Dereje Bayissa Demissie, Bosena Tebeje, Tesfaye T. Fertility desire and associated factors among people living with HIV attending antiretroviral therapy clinic in Ethiopia. BMC Pregnancy and Childbirth 2014; 14: 382. |
[20]
where PLHIV since when the duration of HIVdiagnosis was made withinone yearhad higher odds of fertility desire as compared to those who knew their status before four years. Furthermore, PLHIV who had a perceived improved health statuswere more likely to desire forchildren than those who had no any change and this is supported by other studies where a self-rating improved overall personal health status and physical functioningwere associated with the increased in fertility desire
| [5] | Nattabi BLJ, Thompson SC, Orach CG, Earnest J: A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav 2009, 13(5): 949-968. |
| [17] | Elia J Mmbaga, Germana H Leyna, Mangi J Ezekiel, Kakoko DC. Fertility desire and intention of people living with HIV/AIDS in Tanzania: a call for restructuring care and treatment services. BMC Public Health 2013; 13: 86. |
| [38] | Cooper D, Jennifer Moodley VZ, Linda-Gail Bekker IS, Myer L: 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. AIDS Behav 2009, 13(supplement 1): 38-46. |
[5, 17, 38]
. In this case the PLHIV might be under ART follow up and care for a long period of time and thus will have an improved health status; i.e., an increased in the CD4 cells, which is a surrogate measure of a stronger immunity and a better health status, which enable them to decide on fertility desire in the future. In addition to this, health care providers might advise their clients on the efficacy of PMTCT and the timely practicable options for HIV prevention rather than emphasizing the risks associated with it.
The odds of having fertility desire was higher among PLHIV who discussed about sexuality, fertility desire and family planning with an ART provider as compared to those who didn’t have discussion. This is in line with a study done in Finoteselam Hospital, Northwest Ethiopia
| [24] | Central Statistical Agency [Ethiopia], ICF international: Ethiopia demographic and health survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central statistical agency and ICF international; 2012. |
[24]
. This could be due to the fact that ART providers might advise their clients on the growing issues or concerns during pregnancy, delivery and child feeding practices, the current available options of HIV prevention including PMTCT service and the like to make a responsible voluntary decision about their reproduction. On the other way round, due to the societal culture related to childbearing, PLHIV might push the ART provider to approve their desire and the necessary and appropriate measures they should take.
5. Conclusion
Nearly half of the PLHIV had reported fertility desire in the future. In this study a perceived improved health status, faced partner and community pressure to have a child, had no live birth and discussed about sexuality, fertility desire and family planning with ART provider were significantly associated with fertility desire. Therefore, there should be a concerted effort; i.e., health care providers and the concerned bodies should work together in strengthening the reproductive health needs of PLHIV along with HIV care and support so that they may decide freely and responsibly on their own reproductive health matters.
Abbreviation
ART | Assisted Reproductive Technology |
ARV | Anti Retro Viral |
CI | Confidence Interval |
HA | Highly Active Antiretroviral Therapy |
HBC | Home Base HIV Care |
HIV | Human Immune Deficiency Virus |
LFTU | Left to Follow Up |
MTCT | Mother to Child Transmission of HIV |
OR | Odds Ratio |
PLWH | People Living with HIV/ AIDS |
PMTCT | Prevention Mother to Child HIV Transmission |
SPSS | Statistical Package for Social Sciences |
Acknowledgments
We would like to thank Debre Markos University and GAMBY College of Medical Sciences for the technical support. In addition, we would like to thank our data collectors and the supervisors for their invaluable effort as well as the study participants who volunteered and took their time to give us all the relevant information for the study. Last but not least, we would like to thank Addis Ababa Health Bureau and all sub city health departments and health centers for their support throughout the data collection period.
Author Contributions
Mohammed Hassen: Conceptualization, Formal Analysis, Funding acquisition, Investigation, Methodology, Software, Supervision, Writing – original draft
Teketo Kassaw: Project administration, Software, Validation
Assefa Taresa: Supervision, Validation
Conflicts of Interest
The authors declare no conflicts of interest.
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|
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APA Style
Hassen, M., Kassaw, T., Taresa, A. (2025). Fertility Desire and Its Associated Factors Among People Living with HIV Attending Antiretroviral Therapy in Addis Ababa, Ethiopia. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 11(2), 90-98. https://doi.org/10.11648/j.ijhpebs.20251102.14
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Hassen, M.; Kassaw, T.; Taresa, A. Fertility Desire and Its Associated Factors Among People Living with HIV Attending Antiretroviral Therapy in Addis Ababa, Ethiopia. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2025, 11(2), 90-98. doi: 10.11648/j.ijhpebs.20251102.14
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AMA Style
Hassen M, Kassaw T, Taresa A. Fertility Desire and Its Associated Factors Among People Living with HIV Attending Antiretroviral Therapy in Addis Ababa, Ethiopia. Int J HIV/AIDS Prev Educ Behav Sci. 2025;11(2):90-98. doi: 10.11648/j.ijhpebs.20251102.14
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@article{10.11648/j.ijhpebs.20251102.14,
author = {Mohammed Hassen and Teketo Kassaw and Asefa Taresa},
title = {Fertility Desire and Its Associated Factors Among People Living with HIV Attending Antiretroviral Therapy in Addis Ababa, Ethiopia},
journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
volume = {11},
number = {2},
pages = {90-98},
doi = {10.11648/j.ijhpebs.20251102.14},
url = {https://doi.org/10.11648/j.ijhpebs.20251102.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20251102.14},
abstract = {Background: Worldwide, due to the increased in the accessibility of antiretroviral therapy the number of people living with HIV (PLHIV) is increasing. The treatment has improved the health status and life expectancy of PLHIV making them to enjoy life similar to uninfected individuals. Even though efforts are being made directed towards expanding the service globally and in sub-Saharan Africa, but little attention is given towards the reproductive health needs of PLHIV. Now a day’s people living HIV continued to desire a child requiring a global attention. Therefore, this study was aimed to assess fertility desire and the associated factors among people living with HIV in Addis Ababa, Ethiopia, 2023/24. Method: A health facility based cross-sectional study was conducted among 602 people living with HIV in Addis Ababa, Ethiopia. A multi-stage sampling technique was used to select the study participants. Using SPSS version 27 binary and multivariable logistic regression was done to ascertain the factors associated with fertility desire with a 95% confidence interval. Results: In the past six months 83.1% of the PLHIV were sexually active. Overall, nearly half (47.25%) of the PLHIV had reported fertility desire. People living with HIV who had no child had a higher odds of fertility desire (AOR (95% C.I): 2.70 (1.71- 4.24)) than who had children. In addition to this, being single, partner fertility desire, discussion with an ART provider about sexuality, fertility desire and family planning, had faced community pressure to have a child, perceived improved health status, had an HIV negative sexual partner and HIV diagnosed before nine years were found to be predictors of fertility intentions. Conclusion: Nearly half of the PLHIV had reported fertility desire in the future where discussion about sexuality, fertility desire and family planning with ART provider had showna significant association with it. Therefore, health care providers and the concerned bodies should work together in strengthening the reproductive health needs of PLHIV along with HIV care and support so that they may decide freely and responsibly on their own reproductive health matters.},
year = {2025}
}
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TY - JOUR
T1 - Fertility Desire and Its Associated Factors Among People Living with HIV Attending Antiretroviral Therapy in Addis Ababa, Ethiopia
AU - Mohammed Hassen
AU - Teketo Kassaw
AU - Asefa Taresa
Y1 - 2025/12/09
PY - 2025
N1 - https://doi.org/10.11648/j.ijhpebs.20251102.14
DO - 10.11648/j.ijhpebs.20251102.14
T2 - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP - 90
EP - 98
PB - Science Publishing Group
SN - 2575-5765
UR - https://doi.org/10.11648/j.ijhpebs.20251102.14
AB - Background: Worldwide, due to the increased in the accessibility of antiretroviral therapy the number of people living with HIV (PLHIV) is increasing. The treatment has improved the health status and life expectancy of PLHIV making them to enjoy life similar to uninfected individuals. Even though efforts are being made directed towards expanding the service globally and in sub-Saharan Africa, but little attention is given towards the reproductive health needs of PLHIV. Now a day’s people living HIV continued to desire a child requiring a global attention. Therefore, this study was aimed to assess fertility desire and the associated factors among people living with HIV in Addis Ababa, Ethiopia, 2023/24. Method: A health facility based cross-sectional study was conducted among 602 people living with HIV in Addis Ababa, Ethiopia. A multi-stage sampling technique was used to select the study participants. Using SPSS version 27 binary and multivariable logistic regression was done to ascertain the factors associated with fertility desire with a 95% confidence interval. Results: In the past six months 83.1% of the PLHIV were sexually active. Overall, nearly half (47.25%) of the PLHIV had reported fertility desire. People living with HIV who had no child had a higher odds of fertility desire (AOR (95% C.I): 2.70 (1.71- 4.24)) than who had children. In addition to this, being single, partner fertility desire, discussion with an ART provider about sexuality, fertility desire and family planning, had faced community pressure to have a child, perceived improved health status, had an HIV negative sexual partner and HIV diagnosed before nine years were found to be predictors of fertility intentions. Conclusion: Nearly half of the PLHIV had reported fertility desire in the future where discussion about sexuality, fertility desire and family planning with ART provider had showna significant association with it. Therefore, health care providers and the concerned bodies should work together in strengthening the reproductive health needs of PLHIV along with HIV care and support so that they may decide freely and responsibly on their own reproductive health matters.
VL - 11
IS - 2
ER -
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