Remera Eric, Boer Kimberly, Umuhoza Stella M, Hedt-Gauthier Bethany L, Thomson Dana R, Ndimubanzi Patrick, Kayirangwa Eugenie, Mutsinzi Salomon, Bayingana Alice, Mugwaneza Placidie, Koama Jean Baptiste T
Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda.
Centers for Disease Control and Prevention, Kigali, Rwanda.
Reprod Health. 2017 Mar 14;14(1):40. doi: 10.1186/s12978-017-0301-x.
HIV infection is linked to decreased fertility and fertility desires in sub-Saharan Africa due to biological and social factors. We investigate the relationship between HIV infection and fertility or fertility desires in the context of universal access to antiretroviral therapy introduced in 2004 in Rwanda.
We used data from 3532 and 4527 women aged 20-49 from the 2005 and 2010 Rwandan Demographic and Health Surveys (RDHS), respectively. The RDHSs included blood-tests for HIV, as well as detailed interviews about fertility, demographic and behavioral outcomes. In both years, multiple logistic regression was used to assess the association between HIV and fertility outcomes within three age categories (20-29, 30-39 and 40-49 years), controlling for confounders and compensating for the complex survey design.
In 2010, we did not find a difference in the odds of pregnancy in the last 5 years between HIV-seropositive and HIV-seronegative women after controlling for potential biological and social confounders. Controlling for the same confounders, we found that HIV-seropositive women under age 40 were less likely to desire more children compared to HIV-seronegative women (20-29 years adjusted odds ratio (AOR) = 0.31, 95% CI: 0.17, 0.58; 30-39 years AOR = 0.24, 95% CI: 0.14, 0.43), but no difference was found among women aged 40 or older. No associations between HIV and fertility or fertility desire were found in 2005.
These findings suggest no difference in births or current pregnancy among HIV-seropositive and HIV-seronegative women. That in 2010 HIV-seropositive women in their earlier childbearing years desired fewer children than HIV-seronegative women could suggest more women with HIV survived; and stigma, fear of transmitting HIV, or realism about living with HIV and prematurely dying from HIV may affect their desire to have children. These findings emphasize the importance of delivering appropriate information about pregnancy and childbearing to HIV-infected women, enabling women living with HIV to make informed decisions about their reproductive life.
在撒哈拉以南非洲，由于生物学和社会因素，艾滋病毒感染与生育力下降及生育意愿降低有关。我们在卢旺达2004年引入普遍获得抗逆转录病毒疗法的背景下，调查艾滋病毒感染与生育力或生育意愿之间的关系。
我们分别使用了2005年和2010年卢旺达人口与健康调查（RDHS）中3532名和4527名年龄在20 - 49岁之间女性的数据。RDHS包括艾滋病毒血液检测，以及关于生育、人口统计学和行为结果的详细访谈。在这两年中，采用多因素逻辑回归来评估艾滋病毒与三个年龄组（20 - 29岁、30 - 39岁和40 - 49岁）内生育结果之间的关联，控制混杂因素并对复杂的调查设计进行校正。
2010年，在控制了潜在的生物学和社会混杂因素后，我们发现艾滋病毒血清阳性和血清阴性女性在过去5年的怀孕几率没有差异。在控制相同的混杂因素后，我们发现40岁以下的艾滋病毒血清阳性女性比血清阴性女性想要更多孩子的可能性更小（20 - 29岁调整优势比（AOR）= 0.31，95%可信区间：0.17，0.58；30 - 39岁AOR = 0.24，95%可信区间：0.14，0.43），但40岁及以上女性之间未发现差异。2005年未发现艾滋病毒与生育力或生育意愿之间存在关联。
这些发现表明，艾滋病毒血清阳性和血清阴性女性在生育或当前怀孕方面没有差异。2010年，处于生育早期的艾滋病毒血清阳性女性想要的孩子比血清阴性女性少，这可能表明更多感染艾滋病毒的女性存活下来；并且耻辱感、对传播艾滋病毒的恐惧，或者对感染艾滋病毒生活及过早死于艾滋病毒的现实认知可能影响了她们生育孩子的意愿。这些发现强调了向感染艾滋病毒的女性提供有关怀孕和生育的适当信息的重要性, 使感染艾滋病毒的女性能够对其生殖生活做出明智的决定。
