Association between fertility and HIV status: what implications for HIV estimates?
BACKGROUND
Most estimates of HIV prevalence have been based on sentinel surveillance of pregnant women which may either under-estimate or over-estimate the actual prevalence in adult female population. One situation which can lead to either an underestimate or an overestimate of the actual HIV prevalence is where there is a significant difference in fertility rates between HIV-positive and HIV-negative women. Our aim was to compare the fertility rates of HIV-infected and HIV-uninfected women in Cameroon in order to make recommendations on the appropriate adjustments when using antenatal sentinel data to estimate HIV prevalence.


METHODS
Cross-sectional, population-based study using data from 4493 sexually active women aged 15 to 49 years who participated in the 2004 Cameroon Demographic and Health Survey.


RESULTS
In the rural area, the age-specific fertility rates in both HIV positive and HIV negative women increased from 15-19 years age bracket to a maximum at 20-24 years and then decreased monotonically till 35-49 years. Similar trends were observed in the urban area. The overall fertility rate for HIV positive women was 118.7 births per 1000 woman-years (95% Confidence Interval [CI] 98.4 to 142.0) compared to 171.3 births per 1000 woman-years (95% CI 164.5 to 178.2) for HIV negative women. The ratio of the fertility rate in HIV positive women to the fertility rate of HIV negative women (called the relative inclusion ratio) was 0.69 (95% CI 0.62 to 0.75).


CONCLUSIONS
Fertility rates are lower in HIV-positive than HIV-negative women in Cameroon. The findings of this study support the use of summary RIR for the adjustment of HIV prevalence (among adult female population) obtained from sentinel surveillance in antenatal clinics.
Kongnyuy
Eugene J
EJ
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK. kongnyuy@gmail.com
Wiysonge
Charles S
CS
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001723:Birth Rate; D002163:Cameroon / Q000453:epidemiology; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D018023:HIV Seronegativity / Q000502:physiology*; D006679:HIV Seropositivity / Q000503:physiopathology; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D018571:Sentinel Surveillance; D012923:Social Class
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