What is the relationship between increased access to HAART, relationship status and fertility decisions amongst HIV positive women? A literature review and meta-analysis

AIMS AND OBJECTIVES: To investigate the relationship between fertility decisions, to have already had a child or to desire to have one in the future, and the prognostic factors of; access to antiretrovirals, the time since these became widely available (year of the study) and relationship status. BACKGROUND: There have been significant advances in the treatment of Human Immunodeficiency Virus (HIV) with the advent of antiretroviral therapy which has been used to successfully reduce the rate of mother to child transmission; leading researchers to hypothesise that HIV positive women may desire to have children more so now than in the past. However, this topic is often not discussed in healthcare consultations. METHODS: A systematic search was conducted on CINAHL and Medline, using the key terms ‘fertility decisions’ and ‘HIV positive’. A meta-analysis of proportions and a meta-regression were conducted using a random effects model and a logit transformation to normalise the data. Heterogeneity was assessed using Q, I2 and R2 values and p-values were produced for each regressed variable. FINDINGS: There was no statistically significant relationship between a desire to have children in the future and any of the prognostic variables. Although, there were statistically significant relationships between already having had at least one child; being on antiretroviral therapy; wanting a child in the future; and being in a cohabiting partnership or marriage. CONCLUSION: There are no reliable prognostic variables which can be used to predict fertility intentions in HIV positive women. There are, however, a significant proportion of women who wish to have children or who have already had children and are in need of reproductive counselling from their healthcare providers. RELEVANCE TO CLINICAL PRACTICE: A greater knowledge of factors which may influence reproductive decisions amongst HIV positive position will allow healthcare professionals to individualise the care they provide.

• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Prevention
  • Biomedical interventions