HIV is increasingly recognised as a chronic disease

With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision-making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among people living with HIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of people living with HIV.

This interesting systematic review of studies of fertility desires and intentions reveals the importance of mixed methodologies (quantitative and qualitative) to contextualise findings and emphasises the use of theoretical frameworks relevant to cultural context to underpin study design and analyses. In most settings, people living with HIV are uncomfortable talking with health care providers about fertility issues, anticipating or experiencing biased information-giving and negative attitudes. Provision of services within a rights-based framework requires consideration of a risk-reduction approach to minimise vertical and horizontal HIV transmission through nonjudgmental care, treatment, and counselling.