Sociology, City University, London, United Kingdom.
University of Nairobi, Kenya.
Soc Sci Med. 2010 Jul;71(2):335-344. doi: 10.1016/j.socscimed.2010.03.040. Epub 2010 Apr 24.
Findings from previous studies linking the HIV/AIDS epidemic and fertility of populations have remained inconclusive. In sub-Saharan Africa, demographic patterns point to the epidemic resulting in fertility reduction. However, evidence from the 2003 Kenya Demographic and Health Survey (KDHS) has revealed interesting patterns, with regions most adversely affected with HIV/AIDS showing the clearest reversal trend in fertility decline. While there is suggestive evidence that fertility behaviour in some parts of sub-Saharan Africa has changed in relation to the HIV/AIDS epidemic, more rigorous empirical analysis is necessary to better understand this relationship. In this paper, we examine individual and contextual community HIV/AIDS factors associated with fertility patterns in Kenya, paying particular attention to possible mechanisms of the association. Multilevel models are applied to the 2003 KDHS, introducing various proximate fertility determinants in successive stages, to explore possible mechanisms through which HIV/AIDS may be associated with fertility. The results corroborate findings from earlier studies of the fertility inhibiting effect of HIV among infected women. HIV-infected women have 40 percent lower odds of having had a recent birth than their uninfected counterparts of similar background characteristics. Further analysis suggests an association between HIV/AIDS and fertility that exists through proximate fertility determinants relating to sexual exposure, breastfeeding duration, and foetal loss. While HIV/AIDS may have contributed to reduced fertility, mainly through reduced sexual exposure, there is evidence that it has contributed to increased fertility, through reduced breastfeeding and increased desire for more children resulting from increased infant/child mortality (i.e. a replacement phenomenon). In communities at advanced stages of the HIV/AIDS epidemic, it is possible that infant/child mortality has reached appreciably high levels where the impact of replacement and reduced breastfeeding duration is substantial enough to result in a reversal of fertility decline. This provides a plausible explanation for the patterns observed in regions with particularly high HIV prevalence in Kenya.
先前的研究发现，艾滋病毒/艾滋病流行与人口生育率之间的关系尚无定论。在撒哈拉以南非洲，人口模式表明，该流行病导致生育率下降。然而，2003 年肯尼亚人口与健康调查（KDHS）的证据显示出有趣的模式，受艾滋病毒/艾滋病影响最严重的地区生育率下降趋势最为明显。虽然有迹象表明，在撒哈拉以南非洲的一些地区，与艾滋病毒/艾滋病流行有关的生育行为发生了变化，但需要进行更严格的实证分析，以更好地了解这种关系。本文考察了与肯尼亚生育模式相关的个人和社区艾滋病毒/艾滋病因素，特别关注这种关联的可能机制。我们运用多层次模型对 2003 年 KDHS 进行分析，在各个阶段引入各种近期生育决定因素，以探讨艾滋病毒/艾滋病与生育之间可能存在的关联机制。结果证实了先前关于艾滋病毒感染妇女生育率抑制作用的研究结果。感染艾滋病毒的妇女最近生育的可能性比背景特征相似的未感染妇女低 40%。进一步的分析表明，艾滋病毒/艾滋病与生育率之间存在关联，这种关联通过与性接触、母乳喂养持续时间和胎儿死亡有关的近期生育决定因素而存在。尽管艾滋病毒/艾滋病可能通过减少性接触导致生育率下降，但有证据表明，它还可能通过减少母乳喂养和因婴儿/儿童死亡率增加而导致对更多孩子的渴望（即替代现象）导致生育率上升。在艾滋病毒/艾滋病流行处于高级阶段的社区，婴儿/儿童死亡率可能已经达到相当高的水平，替代和减少母乳喂养持续时间的影响足以导致生育率下降的逆转。这为肯尼亚艾滋病毒流行率特别高的地区观察到的模式提供了一个合理的解释。
