Treatment not a major factor in HIV-positive women's desire to have children

The World Health Organization now recommends antiretroviral therapy (ART) for everyone living with HIV, no matter how sick. With ART, HIV-positive women have increased life expectancy and quality of life. This means they face new decisions about their future, including whether they want to have children after receiving treatment.

Researchers from the Kenya Medical Research Institute, UCSF and University of Washington interviewed HIV-positive women in Kenya who had never received ART to see how access to treatment might influence their future desire to have children.

The women interviewed acknowledged that having children is highly valued in their communities, but overall their HIV-positive status made them less likely to want future children. They had concerns about the health consequences of pregnancy, and feared that complications were more likely. They also feared they could transmit HIV to an HIV-negative partner while trying to conceive. They worried about money, anticipating increased healthcare costs during pregnancy. Some noted the burdens of already having HIV-positive children.

Opinions on whether ART would affect their desire to have children varied widely. Some felt that it would improve their health, while others still expected a shorter lifespan despite ART use. It’s possible that women’s desire for children would change once they had actually experienced the health improvements that come with ART.

Ultimately, researchers found that other factors were more important to women’s fertility desires. Individual factors such as their age, how many children they already had, and how many of their children were alive or HIV-positive played a major role. Societal factors were also influential. Nearly all the women reported indirect discouragement from their communities and health care providers.

These findings are crucial for health care providers and HIV treatment programs to understand and meet HIV-positive women’s reproductive health needs. Women living with HIV should be supported with integration of family planning services into HIV care, discussion of their fertility desires, and use of safer conception options or birth control driven by the women’s desires.