Differential Impacts of HIV status on shortterm fertility desires among couples in Rakai, Uganda
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Fertility desires of female and male partners in current relationships are often correlated.
We examined the influence of HIV seropositive status of female and male partners on shortterm
fertility desires in Rakai, Uganda, a setting with high fertility and HIV infection rates.
Methods
Participants were couples (15–49 years old) enrolled in the Rakai Community Cohort Study,
from 2011 to 2013 (n = 2,291). Cohen’s kappa coefficient was used to measure the correlation
of female and male partners’ short-term fertility desires (measured as ‘wanting a child in
the next 12 months’), in both total sample and stratified serostatus groups. HIV serostatus
and additional characteristics of female and male partners were included in Poisson regression
models to estimate the rate ratios (RR) for each partner’s short-term fertility desires.
Individual and partner characteristics included HIV status, partner HIV status, age in years,
partner age in years, educational attainment, number of living children, community of residence,
and socioeconomic status (SES).
Results
Short-term fertility desires among female and male partners were moderately associated
(Kappa = 0.37, p-value<0.001). The association was weakest among female sero-positive
and male sero-negative couples (Kappa = 0.29, p-value<0.001). When adjusting for parity
and other covariates in the model, women’s short-term fertility desires were significantly
associated with their positive sero-status regardless of male partners’ sero-status (adjRR =
1.58, p<0.001 for F+M-; adjRR = 1.33, p = 0.001 for F+M+; in comparison with F-M-). Men’s
short-term fertility desires were significantly associated with their positive sero-status, in addition to their female partners’ positive sero-status (adjRR = 1.23 with p-value = 0.022 for
F-M+; adjRR = 1.42 with p-value<0.001 for F+M-; adjRR = 1.26 with p-value<0.001 for F+M
+; in comparison with F-M-). When the differential effect of parity was included in the model,
similar associations remained for both female and male partners when the number of living
children was small, but largely reduced when the number of living children was large (3 or
more).
Conclusion
Female and male partners in couple dyads demonstrated moderate agreements about
short-term fertility desires. The HIV seropositive status of female partners was most strongly
associated with short-term fertility desires of both genders, and this association was even
stronger for women who had few or no living children.
Description
Keywords
HIV status, Shortterm fertility desires, Couples
Citation
Song X, Grilo SA, Mathur S, Lutalo T, Ssekubugu R, Nalugoda F, et al. (2019) Differential Impacts of HIV status on short-term fertility desires among couples in Rakai, Uganda. PLoS ONE 14(1): e0210935. https://doi.org/10.1371/journal. pone.0210935