title: Factors associated with desire for children among HIV-infected women and men: a quantitative and qualitative analysis from Malawi and implications for the delivery of safer conception counseling.
abstract: Improved health outcomes have resulted in people with HIV facing decisions about childbearing. We sought to understand the factors associated with desire for a child among men and women in Malawi. HIV-infected men and women ages 18-40 were invited to participate in a brief interview about fertility desires. Single variable logistic regression was used to evaluate the factors associated with the outcome of fertility desire. Additionally, multiple logistic regression was used to assess the relationship of all the factors together on the outcome of fertility desire. In-depth interviews with women were performed to understand experiences with reproductive health care. A total of 202 brief interviews were completed with 75 men (37.1%) and 127 women (62.9%), with 103 (51.0%) of respondents desiring a child. Being in a relationship (OR: 3.48, 95% CI: 1.58-7.65, p = 0.002) and duration of HIV more than two years (OR: 2.00, 95% CI: 1.08-3.67, p = 0.03) were associated with increased odds of desire for a child. Age 36-40 years (OR: 0.64, 95% CI: 0.46-0.90, p = 0.009) and having a living child (OR: 0.24, 95% CI: 0.07-0.84, p = 0.03) were associated with decreased odds of desire for a child. Seventy percent of women (n = 19 of 27 respondents) completing semistructured interviews who responded to the question about decision-making reported that their male partners made decisions about children, while the remainder reported the decision was collaborative (n = 8, 30%). Eighty-six percent of women (n = 36 of 42 respondents) reported no discussion or a discouraging discussion with a provider about having children. HIV-infected women and men in Malawi maintain a desire to have children. Interventions are needed to integrate safer conception into HIV care, to improve male participation in safer conception counseling, and to empower providers to help patients make decisions about reproduction free of discrimination and coercion.
authors.affiliation: a Nkhoma Hospital , Nkhoma , Malawi.
authors.forename: Paul
authors.initials: P
authors.lastname: Kawale
authors.forename: Deborah
authors.initials: D
authors.lastname: Mindry
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stramotas
authors.forename: Peter
authors.initials: P
authors.lastname: Chilikoh
authors.forename: Ann
authors.initials: A
authors.lastname: Phoya
authors.forename: Katherine
authors.initials: K
authors.lastname: Henry
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.forename: Perry
authors.initials: P
authors.lastname: Jansen
authors.forename: Risa
authors.initials: R
authors.lastname: Hoffman
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling / Q000379:methods; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000523:psychology / Q000635:transmission*; D006301:Health Services Needs and Demand; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D033182:Intention; D007407:Interviews as Topic; D016015:Logistic Models; D008295:Malawi; D008297:Male; D009042:Motivation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control / Q000523:psychology*; D036301:Qualitative Research; D012098:Reproduction; D012307:Risk Factors; D012747:Sexual Partners / Q000523:psychology; D012959:Socioeconomic Factors; D055815:Young Adult