Fertility desire, intention and associated factors among people living with HIV seeking chronic HIV care at health facilities of Hawassa City, southern Ethiopia

Abstract

INTRODUCTION: Late in HIV epidemic while HIV program is maturing studies in rich and resource limited setting have shown controversial results with regard to whether childbearing desire and intention are changed after the expansion of ART and PMTCT services. There are few studies in Ethiopia which tried to find out fertility preferences after the decentralized ART and PMTCT services. PURPOSE: The objective of the study is to determine the prevalence of fertility desire, intention and associated factors among HIV positive males and females at health facilities in Hawassa city with chronic HIV care. METHOD: The study used quantitative, observational, analytic and cross-sectional study design. It was structured on Trait-Desire-Intention-Behaviour theoretical frame work. A gender based stratification followed by random sampling method was applied. An interviewer-administered structured data collection approach using the pre-tested questionnaire was applied in the study. The Microsoft Office Excel 2007 and Epi-Info version 3.5.3 were utilized for data analysis. In addition to descriptive statistics, both bivariate and multivariable logistic regressions were used to analyse the data. RESULT: With a respondent rate of 93%, a total of 460 PLHIV participated in the study with equal number of males and females. The majority of the participants were from urban (85%), in relationship (70.9%), and on ART (80%). The reported fertility desire, 43.9% (45.2% in males; 42.6% in females), and fertility intention, 44.9% (46.4% in males; 43.4% in females), were high. The median number of intended children was 2. About 54% of PLHIV were using at least one of the contraceptives with 32.4% of unmet need of family planning. Participants with overall experinece of 2 births or less (AOR: 2.4 95% CI 1.32-4.32; p-value=0.0042), without birth experience after HIV diagnosis (AOR:0.52 95% CI 0.28-0.98; p-value=0.0424) and whose partner also desired for childbearing (AOR: 19.73 95%CI 10.81-35.99; p-value=0.0000) were more likely to intend for a/another child.They wished and planned to get birth because; they did not have a/children before or fear of childless stigma (25.3%), ART could help to have negative child (21.8%), importance of parenthood (17.8%) and the desire of once partner (16.8%). The study participants had consulted health care workers (34.2%), approached their partner or their partner had already approached them (27.6%), tried to get a partner or married (17.6%) and stop using family planning (6%) to get pregnant. CONCLUSION: This study highlights high fertility desire and intention in the background of high unmet need for family planning among PLHIV. A development of comprehensive male partner-involved couple counseling protocol, improving the communication HCWs have with PLHIV to emphasize safer conception methods and strengthening all the components of PMCT integrating with other SRH services at chronic HIV clinic are critical.