Fertility Intetions and Reproductive Care Needs Of Hiv Positive Patients In Follow Up Care And Treatment Centres In Enugu Metropolis

Abstract

Background: Individuals living with HIVIAIDS mayor may not desire to have children and in both cases may need various aspects of reproductive health services to achieve that. The degree or extent of these desires and how they vary by individual, social , health and demographic characteristics is however not well understood to inform design of such needed services. . Objective: This study was carried to determine the fertility intentions & reproductive care needs of HIV positive patients in follow up care treatment centers in Enugu state, Nigeria. Method: The reproductive desires and their predictors were studied among 461 PLWHA receiving care at the six major treatment centers in Enugu state. In the study which was a questionnaire-based cross-sectional study, consecutive individuals of HIV-positive men (18-54 years) and HIV-positive women (18-45 years) were interviewed between October and December 2012. The data was analyzed using SPSS version 12 software. Odds ratios (95% confidence intervals) were used to determine the association of different factors with fertility desire and family planning use. Logistic regression analysis was used to assess the relative effect of determinants. Adjustment was made for predictor variables that were significantly related to the outcome variable at the bivariate level. Results: Of all respondents, 60(70.6%) of males and 177(69.4%) of females were sexually active. Only 65(19.4%) of them used condoms. One hundred and sixty seven females (65.5%) and 52(61.2%) males expressed a desire to have more children. Out of these, 16(7.3%), 106(48.4%) and 88(40.2%) wanted to have one, two and three or more children respectively. Significant predictors of higher fertility desires were; age (OR=1.8), duration of diagnosis (OR=0.42), low parity (OR=6.03) and awareness of paterners sero-status (OR 2.3). The multivariate.analyses of the associated factors indicated that decreasing age, shorter time since diagnosis of HIV infection and nondisclosure of sero-status to current partner significantly increase the odds of desire for childbearing. Conclusion: A large proportion of the HIV-po sitive indi viduals in the study were sexually active, desired to have children, and wanted to use family planning, indicating unmet need for reproductive health counseling in general and family planning services in particular. The extent of the fertilit y desire s and intentions of these patients poses a threat to the preventive strategies against vertical and heterosexual transmission of HIV in this region. Recommendation: In view of PLWHAs compelling desire for parenthood, it is recommended that the Federal Ministry of Health in Nigeria should strengthen the implementation of appropriate policies on Family planning integration into HIV/ART services. Also, more funding should be allocated to research efforts to establish as a mainstay, modem technologies to assist in conception in sero-discordant couples who wish to have children Certain population based studies in Nigeria like National Demographic Health Survey should include such specific studies especially in view of HIV as a major public health challenge to pro vide a wider community view on such issues.