Difficult decisions: Evaluating individual and couple-level fertility intentions and HIV acquisition among HIV serodiscordant couples in Zambia

• Type of Material: Article
• Authors: Dvora Leah Joseph Davey, Emory University; Kristin Wall, Emory University; William Kilembe, Emory University; Naw Htee Khu, Emory University; Ilene Brill, Emory University; Bellington Vwalika, Emory University; Elwyn Chomba, University of Zambia; Joseph Mulenga, Emory University; Amanda Tichacek, Emory University; Pamina M. Gorbach, University of California Los Angeles; Susan A Allen, Emory University
• Language: English
• Date: 2018-01-24
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Joseph Davey et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0189869
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 13
• Issue: 1
• Start Page: e0189869
• End Page: e0189869
• Grant/Funding Information: Co-authors were funded in part by all fund sources at one time or another, except for the lead author. Dr. Joseph Davey had funding support, including salary from NIH-NIAID-T32DA023356 and NIH/FIC R25TW009340.; This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID).; This study was supported by the National Institute of Child Health and Development (NICHD RO1 HD40125); National Institute of Mental Health (NIMH R01 66767); the AIDS International Training and Research Program Fogarty International Center (D43 TW001042); the Emory Center for AIDS Research (P30 AI050409); National Institute of Allergy and Infectious Diseases (NIAID R01 AI51231; NIAID R01 AI040951; NIAID R01 AI023980; NIAID R01 AI64060; NIAID R37 AI51231); the US Centers for Disease Control and Prevention (5U2GPS000758); and the International AIDS Vaccine Initiative.
• Keywords: Multidisciplinary Sciences; Science & Technology - Other Topics; POSITIVE WOMEN; ANTIRETROVIRAL THERAPY; Science & Technology; RISK; DISCORDANT COUPLES; SOUTH-AFRICA; SUB-SAHARAN AFRICA; TRANSMISSION; HUMAN-IMMUNODEFICIENCY-VIRUS; GENITAL INFLAMMATION; HEALTH-CARE
• Research Categories: Health Sciences, Public Health; Health Sciences, Pathology

Abstract

Introduction Attempts to conceive and pregnancy may increase HIV transmission to sex partners and infants. Our study evaluated the association between fertility intentions and HIV acquisition among Zambian HIV-serodiscordant couples. Methods We collected demographic, behavioral, clinical exposures, and data on fertility intentions in a cohort of HIV-serodiscordant couples in Lusaka, Zambia from 2005 to 2012. We evaluated factors associated with fertility intentions stratified by gender using multivariable logistic regression. Multivariable Cox proportional hazard models were used to evaluate the associations between fertility intentions and HIV acquisition controlling for a priori confounders and covariates that substantially (>10%) changed the effect estimates in univariate analyses. Results Among 1,029 serodiscordant couples, 311 agreed that they wanted children in the future (30%), 368 agreed they did not want children (36%), and 344 couples disagreed about having children (34%), with men more likely than women to want children. Women wanting child (ren) was associated with increased odds of baseline pregnancy (adjusted odds ratio [aOR] = 4.80 (95% confidence interval [CI] = 2.93, 7.85)), fewer previous pregnancies (aOR = 0.85 per additional pregnancy (95% CI = 0.78, 0.93)), and partner fertility intention (aOR = 2.89 (95% CI = 2.14, 3.91)) adjusting for woman’s age, literacy, years cohabiting and HIV status. Men wanting child(ren) was associated with younger age (aOR = 0.96 per year (95% CI = 0.93, 0.99)), fewer years cohabiting (aOR = 0.95 (95% CI = 0.92, 0.98)), number of previous partners’ pregnancies (aOR = 0.90 (95% CI = 0.82, 0.98)), and partner fertility intention (aOR = 3.00 (95% CI = 2.21, 4.07)) adjusting for partner’s age, literacy, HIV status and partner’s baseline pregnancy. In adjusted survival analyses, HIV-negative women were more likely to seroconvert if they themselves wanted children (aHR = 2.36 (95% CI = 1.41, 3.96)) vs. did not want children, or if their partner wanted children (aHR = 2.34 (95% CI = 1.33, 4.11)) vs. did not want children, or if the couple agreed that they wanted children (aHR = 2.08 (95% CI = 1.01, 4.30)), adjusting for women’s age, women’s literacy, previous pregnancies and time in study. HIV-negative men were more likely to seroconvert if their female partner wanted a child in the next 12-months (aHR = 1.94 (95% CI = 1.02, 3.68)) vs. did not want children, and when both partners wanted children (aHR = 2.02 (CI = 1.09, 3.73)) vs. they did not want children, adjusting for men’s age and literacy, couple income, number of live children, male circumcision status and time in study. Conclusion Women had increased risk of HIV acquisition if they and/or their partner wanted a child, while men had increased risk of HIV acquisition when their partner or if both partners agreed that they wanted children. Safer-conception interventions are needed to protect HIV uninfected women and men from HIV acquisition in HIV-serodiscordant couples who want children.