Factors associated with desired fertility among HIV-positive women and men attending two urban clinics in Lilongwe, Malawi

As access to antiretroviral therapy increases, more HIV-infected patients in sub-Saharan Africa may desire fertility. We conducted a cross-sectional study of reproductive health knowledge, attitudes and practices to identify factors associated with desired fertility among women and men receiving care at two large public HIV clinics in Lilongwe, Malawi. Research assistants administered questionnaires to participants. We performed descriptive, bivariable and multivariable analysis of factors related to desired fertility and of factors related to contraceptive non-use among participants who did not desire fertility. One-third of participants desired future children. Having a partner who desired fertility and having lower parity were associated with desiring children among both genders. For women, believing that pregnancy was unhealthy was associated with decreased fertility desire. Fifty-five percent of women and 69% of men who did not want children in the future reported using contraception at last intercourse. Increasing age, lower parity, and making the decision to use contraception herself were associated with contraceptive non-use among women who did not desire fertility. Having discussed family planning with his partner was associated with contraceptive use among men who did not desire fertility. Knowledge of these factors can guide reproductive health counseling and service provision.

随着抗逆转录病毒疗法（antiretroviral therapy）可及性不断提升，撒哈拉以南非洲地区更多艾滋病病毒（HIV）感染者或产生生育意愿。本研究针对马拉维利隆圭两家大型公立艾滋病诊疗所的就诊男女患者开展横断面研究（cross-sectional study），旨在探究与生育意愿相关的影响因素，调研内容涵盖生殖健康知识、态度与行为实践。研究助理向参与者发放调查问卷，我们针对生育意愿相关影响因素，以及无生育意愿参与者的未使用避孕措施相关影响因素，分别开展描述性分析、双变量分析（bivariable analysis）及多变量分析（multivariable analysis）。三分之一的参与者表示希望未来生育。无论男女，拥有具有生育意愿的伴侣以及较低的经产次数（parity）均与生育意愿呈显著正相关。对于女性而言，认为妊娠有害健康与生育意愿降低显著相关。在无未来生育意愿的参与者中，55%的女性与69%的男性报告称末次性交时使用了避孕措施（contraception）。在无生育意愿的女性群体中，年龄增长、经产次数较低以及自主决定使用避孕措施与未使用避孕措施显著相关；对于无生育意愿的男性而言，与伴侣讨论过计划生育（family planning）与使用避孕措施显著相关。明晰上述影响因素，可为生殖健康咨询与服务供给提供科学指导。