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AIDS and Behavior

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01.06.2009 | Original Research

The Impact of HIV Status and Perceived Status on Fertility Desires in Rural Malawi

verfasst von: Sara E. Yeatman

Erschienen in: AIDS and Behavior | Sonderheft 1/2009

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Abstract

Surprisingly little is known about how or if knowledge of one’s HIV status influences the desire to have children in sub-Saharan Africa. This paper takes advantage of a unique situation in rural Malawi where no one knew their HIV status prior to testing being introduced as part of an ongoing panel study. Using a sample of men and women (n = 1,380) who were interviewed in 2001 and 2006, we examine how HIV positive and negative test results impact respondents’ desires to continue childbearing. We then consider how prior perceptions of one’s status influence this effect. Respondents who received a positive test result reduced their childbearing desires. When self-assessed likelihood of infection was considered, however, only those who were surprised by their test result altered their fertility preferences, a finding which held true for both positive and negative results. The implications of the results and potential applications to other HIV/AIDS research are discussed.

Malawi Diffusion and Ideational Change Project (PIs Susan Watkins, Hans-Peter Kohler and Jere Behrman). Detailed descriptions of the MDICP sample selection, data collection and data quality are provided in a 2003 Special Collection of the online journal Demographic Research that is devoted to the MDICP and on the project website: http://www.malawi.pop.upenn.edu/.

This group includes those who said they “do not know”. This is a difficult group to categorize. While their actual HIV prevalence was similar to those who thought they had a high likelihood of infection, what is relevant here is what they thought of their risk. The analyses were run with this group in both categories, as well as dropped entirely. The results did not change substantially; the method chosen was considered to be a conservative approach.

HIV prevalence for the entire 2004 MDICP sample was 6.7%–5.7% of men and 7.6% of women (though they did not all receive their test result). The longitudinal sample has lower HIV prevalence because of disproportionate attrition among HIV positive individuals—HIV positive individuals in 2004 were more likely to have died and more likely to not be found in 2006. The potential bias introduced is not believed to substantially affect the results because there is no clear theoretical reason why mortality would be higher among infected persons who were more or less likely to change their fertility preferences. In fact, the findings are most relevant to those with lower mortality—the least ill—whose fertility preferences are of greater demographic and epidemiologic relevance.

Tested using subgroup analysis (Altman and Bland 2003)

Abadie, A. (2005). Semiparametric difference-in-differences estimators. Review of Economic Studies, 72, 1–19. doi:10.1111/0034-6527.00321.CrossRef

Aka-Dago-Akribi, H., Desgrees du Lou, A., Msellati, P., Dossou, R., & Welffens-Ekra, C. (1999). Issues surrounding reproductive choice for women living with HIV in Abidjan, Cote d’Ivoire. Reproductive Health Matters, 7, 20–29. doi:10.1016/S0968-8080(99)90108-8.CrossRef

Allen, S., Serufilira, A., Gruber, V., Kegeles, S., Vandeperre, P., Carael, M., et al. (1993). Pregnancy and contraception use among urban Rwandan women after HIV testing and counselling. American Journal of Public Health, 83, 705–710. doi:10.2105/AJPH.83.5.705.PubMedCrossRef

Altman, D. G., & Bland, J. M. (2003). Interaction revisited: The difference between two estimates. (Statistics notes). British Medical Journal, 326(1), 219.PubMedCrossRef

Anglewicz, P., & Kohler, H. P. (2009). Overestimating HIV Infection: The construction and accuracy of subjective probabilities of HIV infection in rural Malawi. Demographic Research, 20, 65–96.CrossRef

Baylies, C. (2000). The impact of HIV on family size preference in Zambia. Reproductive Health Matters, 8, 77–86. doi:10.1016/S0968-8080(00)90008-9.PubMedCrossRef

Bignami-Van Assche, S., Chao, L. W., Anglewicz, P., Chilongozi, D., & Bula, A. (2007). The validity of self-reported likelihood of HIV infection among the general population in rural Malawi. Sexually Transmitted Infections, 83, 35–40. doi:10.1136/sti.2006.020545.PubMedCrossRef

Bongaarts, J. (1990). The measurement of wanted fertility. Population and Development Review, 16, 487–506. doi:10.2307/1972833.CrossRef

Casterline, J. B. (2002). HIV/AIDS and fertility in sub-Saharan Africa: A review of the recent literature. New York: United Nations.

Cooper, D., Harries, J., Myer, L., Orner, P., & Bracken, H. (2007). “Life is still going on”: Reproductive intentions among HIV-positive women and men in South Africa. Social Science and Medicine, 65, 274–283. doi:10.1016/j.socscimed.2007.03.019.PubMedCrossRef

Desgrees-du-Lou, A., Msellati, P., Yao, A., Noba, V., Viho, I., Ramon, R., et al. (1999). Impaired fertility in HIV-1-infected pregnant women: A clinic-based survey in Abidjan, Cote d’Ivoire, 1997. AIDS (London, England), 13, 517–521. doi:10.1097/00002030-199903110-00011.

Gregson, S. (1994). Will HIV become a major determinant of fertility in sub-Saharan Africa. The Journal of Development Studies, 30, 650–679. doi:10.1080/00220389408422331.CrossRef

Gregson, S., Mushati, P., & Nyamukapa, C. (2007). Adult mortality and erosion of household viability in AIDS-afflicted towns, estates, and villages in eastern Zimbabwe. JAIDS Journal of Acquired Immune Deficiency Syndromes, 44, 188–195. doi:10.1097/01.qai.0000247230.68246.13.CrossRef

Grieser, M., Gittelsohn, J., Shankar, A. V., Koppenhaver, T., Legrand, T. K., Marindo, R., et al. (2001). Reproductive decision making and the HIV/AIDS epidemic in Zimbabwe. Journal of Southern African Studies, 27, 225–243. doi:10.1080/03057070120049949.CrossRef

Heuveline, P. (2004). Impact of the HIV epidemic on population and household structure: the dynamics and evidence to date. AIDS (London, England), 18, S45–S53. doi:10.1097/00002030-200406002-00006.

Hoffman, I. F., Martinson, F. E. A., Powers, K. A., Chilongozi, D. A., Msiska, E. D., Kachipapa, E. I., et al. (2008). The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women. JAIDS Journal of Acquired Immune Deficiency Syndromes, 47, 477–483.CrossRef

Lewis, J. J. C., Ronsmans, C., Ezeh, A., & Gregson, S. (2004). The population impact of HIV on fertility in sub-Saharan Africa. AIDS (London, England), 18, S35–S43. doi:10.1097/00002030-200406002-00005.

Libamba, E., Makombe, S., Mhango, E., de AscurraTeck, Limbambala, O., Schouten, E. J., et al. (2006). Supervision, monitoring and evaluation of nationwide scale-up of antiretroviral therapy in Malawi. Bulletin of the World Health Organization, 84, 320–326.PubMed

Lutalo, T., Kidugavu, M., Wawer, M. J., Serwadda, D., Zabin, L. S., & Gray, R. H. (2000). Trends and determinants of contraceptive use in Rakai District, Uganda, 1995–98. Studies in Family Planning, 31, 217–227. doi:10.1111/j.1728-4465.2000.00217.x.PubMedCrossRef

Meyer, B. D. (1995). Quasi-experiments natural in economics. Journal of Business & Economic Statistics, 13, 151–161. doi:10.2307/1392369.CrossRef

Ministry of Health and Population. (2007). ART in the public sector in Malawi, results up to 31st December 2006. HIV/AIDS Unit. Lilongwe, Malawi: Department of Clinical Services.

Moyo, W., & Mbizvo, M. T. (2004). Desire for a future pregnancy among women in Zimbabwe in relation to their self-perceived risk of HIV infection, child mortality, and spontaneous abortion. AIDS and Behavior, 8, 9–15.PubMedCrossRef

Nguyen, R. H. N., Gange, S. J., Wabwire-Mangen, F., Sewankambo, N. K., Serwadda, D., Wawer, M. J., et al. (2006). Reduced fertility among HIV-infected women associated with viral load in Rakai district, Uganda. International Journal of STD and AIDS, 17, 842–846. doi:10.1258/095646206779307586.PubMedCrossRef

Noel-Miller, C. (2003). Concern regarding the HIV/AIDS epidemic and individual childbearing evidence from rural Malawi. Demographic Research Special Collection, 1, 319–348.CrossRef

Ntozi, J. P., & Kirunga, C. T. (1998). Family planning and HIV/AIDS in sub-Saharan Africa: Challenges and strategies. African Journal of Reproductive Health, 2, 44–56.

Pritchett, L. H. (1994). Desired fertility and the impact of population policies. Population and Development Review, 20, 1–55. doi:10.2307/2137629.CrossRef

Ross, A., Van derPaal, L., Lubega, R., Mayanja, B. N., Shafer, L. A., & Whitworth, J. (2004). HIV-1 disease progression and fertility: The incidence of recognized pregnancy and pregnancy outcome in Uganda. AIDS (London, England), 18, 799–804. doi:10.1097/00002030-200403260-00012.

Rutenberg, N., Biddlecom, A. E., & Kaona, F. A. D. (2000). Reproductive decision-making in the context of HIV and AIDS: A qualitative study in Ndola, Zambia. International Family Planning Perspectives, 26, 124–130. doi:10.2307/2648301.CrossRef

Setel, P. (1995). The effect of HIV and AIDS on fertility in East and Central Africa. Health Transition Review, 5, 179–189.PubMed

Shelton, J. (2008). Counseling and testing for HIV prevention. Lancet, 372, 273–275. doi:10.1016/S0140-6736(08)61091-0.PubMedCrossRef

Smith, K. P., & Watkins, S. C. (2005). Perceptions of risk and strategies for prevention: responses to HIV/AIDS in rural Malawi. Social Science and Medicine, 60, 649–660. doi:10.1016/j.socscimed.2004.06.009.PubMedCrossRef

Temmerman, M., Chomba, E. N., & Piot, P. (1994). HIV-1 and reproductive health in Africa. International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics, 44, 107–112. doi:10.1016/0020-7292(94)90062-0.

Temmerman, M., Moses, S., Kiragu, D., Fusallah, S., Wamola, L. A., & Piot, P. (1990). Impact of single session post-partum counseling of HIV infected women on their subsequent reproductive behavior. AIDS Care, 2, 247–252. doi:10.1080/09540129008257737.PubMedCrossRef

Thomson, E., McDonald, E., & Bumpass, L. L. (1990). Fertility desires and fertility–hers, his, and theirs. Demography, 27, 579–588. doi:10.2307/2061571.PubMedCrossRef

Thornton, R., & Bula, A.Chavula, K.,Bignami-Van Assche, S. and Watkins, S.C. (2005) Reactions to voluntary counselling and testing in rural Malawi. Malawi diffusion and ideational change project, Working paper, on-line at malawi.pop.upenn.edu.

Watkins, S. C., Zulu, E. M., Kohler, H. P., & Behrman, J. R. (2003). Introduction to social interactions and HIV/AIDS in rural Africa. Demographic Research, S1, 1–30. doi:10.4054/DemRes.2003.S1.1.CrossRef

WHO/UNAIDS/UNICEF.(2008) Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Progress report, June 2008. Geneva: World Health Organization.

Yeatman, S. E. (2007). Ethical and public health considerations in HIV counseling and testing: What do we know and what should that mean for policy? Studies in Family Planning, 38(4), 271–278. doi:10.1111/j.1728-4465.2007.00139.x.PubMedCrossRef

Yeatman, S.E. (2008). Childbearing in an AIDS epidemic. PhD Dissertation. University of Texas at Austin.

Zaba, B., & Gregson, S. (1998). Measuring the impact of HIV on fertility in Africa. AIDS (London, England), 12, S41–S50. doi:10.1097/00002030-199807000-00001.

Titel: The Impact of HIV Status and Perceived Status on Fertility Desires in Rural Malawi
verfasst von: Sara E. Yeatman
Publikationsdatum: 01.06.2009
Verlag: Springer US
Erschienen in: AIDS and Behavior / Ausgabe Sonderheft 1/2009
Print ISSN: 1090-7165
Elektronische ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-009-9534-1

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