Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal.
J Int AIDS Soc. 2019 May;22(5):e25241. doi: 10.1002/jia2.25241.
Better knowledge about fertility desires/intentions among HIV-serodiscordant partners who face unique challenges when considering childbearing may be helpful in the development of targeted reproductive interventions. The aim of this systematic review was to synthesize the published literature regarding the prevalence of fertility desires/intentions and its associated factors among individuals in HIV-serodiscordant relationships while distinguishing low- and middle-income countries (LMIC) from high-income countries (HIC).
A systematic search of all papers published prior to February 2017 was conducted in four electronic databases (PubMed/MEDLINE, PsycINFO, Web of Science and Cochrane Library). Empirical studies published in peer-reviewed journals with individuals in HIV-serodiscordant relationships assessing the prevalence of fertility desires/intentions and/or the associated factors were included in this systematic review. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
After screening 1852 references, 29 studies were included, of which 21 were conducted in LMIC and eight in HIC. A great variability in the prevalence of fertility desires/intentions was observed in LMIC (8% to 84% (one member of the dyad included)). In HIC, the results showed a smaller discrepancy between in the prevalence (32% to 58% (one member of the dyad included)); the prevalence was higher when the couple was the unit of analysis (64% to 73%), which may be related to the fact that all these studies were conducted in the context of assisted reproduction. Few studies examined the factors associated with fertility desires/intentions, and all except one were conducted in LMIC. Individuals (e.g. number of children), couple-level (e.g. belief that the partner wanted children) and structural factors (e.g. discussions with health workers) were found to be associated.
The results of this systematic review suggest that many individuals in HIV-serodiscordant relationships have fertility desires/intentions, although the prevalence is particularly heterogeneous in LMIC in comparison to HIC. Well-known factors such as younger age and a fewer number of living children were consistently associated with increased fertility desires/intentions. Different couple-level factors emerged, reflecting the importance of considering both the individual and the couple. However, further studies that specifically focus on the dyad as the unit of analysis are warranted.
了解面临独特生育挑战的 HIV 血清不一致的伴侣的生育意愿/意图的相关知识，可能有助于制定有针对性的生殖干预措施。本系统综述的目的是综合发表的文献，以了解在 HIV 血清不一致的关系中，个人的生育意愿/意图及其相关因素的流行情况，并区分低收入和中等收入国家（LMIC）和高收入国家（HIC）。
在四个电子数据库（PubMed/MEDLINE、PsycINFO、Web of Science 和 Cochrane Library）中进行了截至 2017 年 2 月之前发表的所有论文的系统检索。本系统综述纳入了在 HIV 血清不一致的关系中评估生育意愿/意图的流行情况及其相关因素的同行评审期刊上发表的经验性研究。本综述符合系统评价和荟萃分析的首选报告项目（PRISMA）指南。
经过筛选 1852 条参考文献，纳入了 29 项研究，其中 21 项在 LMIC 进行，8 项在 HIC 进行。在 LMIC 中，生育意愿/意图的流行情况差异很大（8%至 84%（一对伴侣中的一员））。在 HIC，结果显示，在流行率方面的差异较小（32%至 58%（一对伴侣中的一员））；当夫妇是分析单位时，流行率更高（64%至 73%），这可能与所有这些研究都是在辅助生殖的背景下进行的事实有关。只有少数研究检查了与生育意愿/意图相关的因素，而且所有研究都在 LMIC 进行。发现个体因素（例如，孩子的数量）、夫妻层面因素（例如，伴侣想要孩子的信念）和结构因素（例如，与卫生工作者的讨论）与生育意愿/意图相关。
本系统综述的结果表明，许多 HIV 血清不一致的伴侣有生育意愿/意图，尽管与 HIC 相比，LMIC 的流行情况特别多样化。年龄较小和存活子女较少等众所周知的因素与生育意愿/意图增加一致。出现了不同的夫妻层面因素，反映了既要考虑个体又要考虑夫妻的重要性。然而，需要进一步的研究来专门关注作为分析单位的夫妻。
