The objective of this study was to determine the predictors of fertility behavior (i.e., trying to become pregnant) in a large representative sample of women living with HIV of reproductive age in Ontario, Canada. The Traits-Desires-Intentions-Behavior model was used to examine the key predictors of reproductive decision making and behavior. A total of 320 women living with HIV were included in the current analysis. The women living with HIV were between the ages of 18 and 52 (mean=37.23, SD=7.53), 56.4% had at least one child living in the home, over 40% identified as being of African ethnicity, and the average time since HIV diagnosis was 10.49 years (SD=5.71). In hierarchical multilevel analysis, perceived family support for trying to become pregnant, living in a large metropolitan city (i.e., Toronto), women's fertility desires, and fertility intentions were associated with fertility behavior (χ29=59.97, p<0.001). As only 10.6% of participants reported engaging in fertility-related behavior, while 57.5% intended a pregnancy in the future, identifying barriers to fertility and discrepancies between intentions and behaviors can support policy programs and assist health care providers to better facilitate the fertility goals of women living with HIV.
Get full access to this article
View all access options for this article.
References
1.
RemisRS, SwanteeC, SchiedelL, et al. Report on HIV/AIDS in Ontario 2006. Ontario Ministry of Health and Long-Term Care. http://www.ohemu.utoronto.ca/doc/PHERO2006_report_final.pdf (Last accessed January3, 2014).
2.
LoutfyMR, HartTA, MohammedSS, et al. Fertility desires and intentions of HIV-positive women of reproductive age in Ontario, Canada: A cross-sectional study. PLoS One, 2009; 4:e7925.
3.
SharmaA, FeldmanJG, GolubET, SchmidtJ, SilverS, RobisonE, MinkoffH. Live birth patterns among human immunodeficiency virus-infected women before and after the availability of highly active antiretroviral therapy. Am J Obstet Gynecol, 2007; 196:541.e1–e6.
4.
OgilvieGS, PalepuA, RempleVP, et al. Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada. AIDS, 2007; 21:s83–s88.
5.
Finocchario-KesslerS, SweatMD, DariotisJK, et al. Understanding high fertility desires and intentions among a sample of urban women living with HIV in the United States. AIDS Behav, 2010; 14:1106–1114.
6.
CarterMW, KraftJM, Hatfield-TimajchyK, et al. The reproductive health behaviors of HIV-infected young women in the Unites States: A literature review. AIDS Patient Care STD, 2013; 27:669–680.
7.
Finocchario-KesslerS, SweatMD, DariotisJK, et al. Childbearing motivations, pregnancy desires, and perceived partner response to a pregnancy among urban female youth: does HIV-infection status make a difference?. AIDS Care, 2012; 24:1–11.
8.
FingerJL, ClumGA, TrentME, et al. Desire for pregnancy and risk behavior in young HIV-positive women. AIDS Patient Care STD, 2012; 26:173–180.
9.
MillerWB. Childbearing motivations, desires, and intentions: A theoretical framework. Genet Soc Gen Psychol Monogr, 1994; 120:223–258.
10.
BillariFC, PhilipovD, TestaMR. Attitudes, norms and perceived behavioural control: Explaining fertility intentions in Bulgaria. Eur J Popul, 2009; 25:439–465.
11.
PeymanN, OakleyD. Effective contraceptive use: An exploration of theory-based influences. Health Educ Res, 2009; 24:575–585.
12.
Levesque-LopmanL. Decision and experience: A phenomenological analysis of pregnancy and childbirth. Human Studies, 1983; 6:247–277.
13.
LydonJ, Dunkel-SchetterC, CohanCL, PierceT. Pregnancy decision making as a significant life event: A commitment approach. J Pers Soc Psychol, 1996; 71:141–151.
14.
Finocchario-KesslerS, DariotisJK, SweatMD, et al. Do HIV-infected women want to discuss reproductive plans with providers, and are those conversations occurring?. AIDS Patient Care STD, 2010; 24:317–323.
15.
Finocchario-KesslerS, MabachiN, DariotisJK, et al. “We weren't using condoms because we were trying to conceive”: The need for reproductive counseling for HIV-positive women in clinical care. AIDS Patient Care STD, 2012; 26:700–707.
16.
LoutfyMR, RaboudJM, WongJ, et al. High prevalence of unintended pregnancies in HIV-positive women of reproductive age in Ontario, Canada: A retrospective study. HIV Med, 2012; 13:107–117.
17.
LoutfyMR, BlitzSL, ZhangY, et al. Self-reported preconception care of HIV-positive women of reproductive potential: A retrospective study. J Int Assoc Provid AIDS Care, 2013; 1:1–10.
18.
Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. http://aidsinfo.nih.gov/contentfiles/lvguidelines/perinatalgl.pdf (Last accessed January2, 2014).
19.
WagnerAC, HartTA, MohammedS, et al. Correlates of HIV stigma in HIV-positive women. Arch Womens Ment Health, 2010; 13:207–214.
20.
IvanovaE, HartT, WagnerAC, et al. Correlates of anxiety in women living with HIV of reproductive age. AIDS Behav, 2012; 16:2181–2191.
OladapoOT, OlusojiJD, OkanlawonLO, et al. Fertility desires and intentions of HIV-positive patients at a suburban specialist center. J Natl Med Assoc, 2005; 97:1672–1681.
23.
ChenJL, PhillipsKA, KanouseDE, et al. Fertility desires and intentions of HIV-positive men and women. Fam Plann Perspect, 2001; 33:144–152.
24.
MorinP, PayetteH, MoosMK, et al. Measuring the intensity of pregnancy planning effort. Paediatr Perinat Epidemiol, 2003; 17:97–105.
25.
KennedyLV, SerghidesL, RaboudJM, et al. The importance of motherhood in HIV-positive women of reproductive age in Ontario, Canada. AIDS Care, 2013; 26:777–784.
26.
SPSS Inc. IBM SPSS Statistics for Windows, Version 19.0. [computer program]. IBM Corp.Armony, NY, 2010.
27.
CohenJC, CohenP, WestSG, et al. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. 3rd edition. Lawrence Erlbaum Associates; New Jersey, 2002.
28.
JamshidianM, BentlerPM. ML estimation of mean and covariance structures with missing data using complete data routines. J Educ Behav Stat, 1999; 24:21–41.
29.
SchoenR, AstoneNM, KimYJ, et al., Do fertility intentions affect fertility behavior?. J Marriage Fam, 1999; 61:790–799.
30.
MorganSP, RackinH. The correspondence between fertility intentions and behavior in the United States. Popul Dev Rev, 2010; 36:91–118.
31.
MillerWB, SeveryLJ, PastaDJ. A framework for modeling fertility motivation in couples. Pop Stud, 2004; 58:193–205.
32.
KirshenbaumSB, HirkyAE, CorrealeJ, et al. “Throwing the Dice”: pregnancy decision-making among HIV-positive women in four U.S. cities. Perspect Sex Reprod Health, 2004; 36:106–113.
33.
WilsonEK, KooHP. The relationship context: Its effects on low-income women's desire for a baby. J Marriage Fam, 2006; 68:1326–1340.
34.
ReifS, GolinCE, SmithSR. Barriers to accessing HIV/AIDS care in North Carolina: Rural and urban differences. AIDS Care, 2005; 17:558–565.
35.
GonzalezA, MillerCT, SolomonSE, et al. Size matters: Community size, HIV stigma, and gender differences. AIDS Behav, 2009; 13:1205–1212.
36.
VeinotTC, HarrisR. Talking about, knowing about HIV/AIDS in Canada: A rural-urban comparison. J Rural Health, 2011; 27:310–318.
37.
LoutfyMR, MargoleseS, MoneyDM, et al. Canadian HIV pregnancy planning guidelines. J Obstet Gynaecol Can, 2012; 34:575–590.
38.
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf (Last accessed January2, 2014).
39.
FakoyaA, LambaH, MackieN, et al. British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection 2008. HIV Med, 2008; 9:681–720.
40.
StutterheimSE, BosAE, PryorJB, et al. Psychological and social correlates of HIV status disclosure: The significance of stigma visibility. AIDS Educ Prev, 2011; 23:382–392.
41.
SerovichJM, KimberlyJA, MosackKE, et al. The role of family and friend social support in reducing emotional distress among HIV-positive women. AIDS Care, 2001; 13:335–341.
42.
DiMatteoMR. Social support and patient adherence to medical treatment: A meta-analysis. Health Psychol, 2004; 23:207–218.
43.
KanniappanS, JeyapaulMJ, KalyanwalaS. Desire for motherhood: Exploring HIV-positive women's desires, intentions and decision-making in attaining motherhood. AIDS Care, 2008; 20:625–630.
44.
WesleyY, SmeltzerSC, RedekerNS, et al. Reproductive decision making in mothers with HIV-1. Health Care Women Int, 2001; 21:291–304.
45.
Centers for Disease Control and Prevention. HIV-Specific Criminal Laws. 2013. http://www.cdc.gov/hiv/policies/law/states/exposure.html (Last accessed January10, 2014).
46.
McCrearyLL, FerrerLM, IlaganPR, et al. Context-based advocacy for HIV-positive women making reproductive decisions. J Assoc Nurses AIDS Care, 2003; 14:41–51.
