Fertility Desire and Associated Factors among People Living with Human Immune Virus on Anti-Retro Viral Therapy Southern Ethiopia

Research Article

Austin J Public Health Epidemiol. 2023; 10(2): 1142.

Fertility Desire and Associated Factors among People Living with Human Immune Virus on Anti-Retro Viral Therapy Southern Ethiopia

Hafiso A¹, Asres AW² and Adale AT²*

1Halaba Zone Health department, southern Ethiopia

2Department of Public health, Wolayita sodo University, Ethiopia

*Corresponding author: Adale AT Department of Public Health, Wolayita sodo University POBOX 138, Ethiopia

Received: December 12, 2022; Accepted: February 06, 2023; Published: February 13, 2023


Background: Antiretroviral therapy has increased the life expectancy of people living with HIV/AIDS. The attitude towards fertility desire is increasing, having a better health status and controlling system that addresses the desire of men and women wanting to have healthy children. However, there are limited studies conducted in Ethiopia. Our study has explored the magnitude of fertility desire and associated factors among PLWHIVA on ART in Southern Ethiopia, 2021.

Methods and Materials: A mixed institutional based cross-sectional study was used employing 417 participants. A structured interviewer-administered questionnaire was used to collect quantitative data and key informants interview for a qualitative study. Data were analyzed using SPSS version 21.0 and multivariable logistic regression models and thematic analysis was done for quantitative and qualitative data respectively. P-value less than 5% was considered to declare association.

Result: Four hundred and nine (98%) of the respondents completed the interview. The magnitude of fertility desire was 64.3%. Age range 18–30 years (AOR = 2.971; 95% CI: 1.06, 8.27), negative HIV test result for partners (AOR = 2.790; 95% CI: 1.199, 6.491), partners fertility desire (AOR = 8.740; 95% CI: 3.488, 21.90), community pressure (AOR = 2.352; 95% CI: 1.028, 5.385) and number of children (AOR = 0.713; 95% CI: 0.564, 0.903) were associated factors. Qualitative finding explored pressure from significant others and economic dependency.

Conclusion: Fertility desire was highest and health professional should provide adequate information regarding ART/PMTCT and involving partners in the counseling time.

Keywords: Fertility Desire; Married People; Magnitude; Factors; PLWHIVA; ART.


Globally HIV/AIDS has huge challenged on human development, especially high burden in poor-resource settings. In 2016, women constituted nearly half (17.8 million) of the world’s 36.7 million people living with HIV/AIDS. Fertility desire is want to have child or children in the future [1,2].

Sub-Saharan Africa (SSA) has the highest number of persons living with HIV/AIDS and the highest HIV prevalence among adults (15–49 years) [3]. After learning of their HIV status, many PLWHA continue to want and have children [4]. Pregnancy was formerly avoided among HIV-positive women due to the potential of vertical transmission. Vertical transmission is unlikely in today’s world if PLWHA achieves adequate viral suppression with combination antiretroviral therapy (cART). PLWHA have a better likelihood of having children as a result of these circumstances. PLWHA believes that having children will strengthen their marriage and that their children will take better care of them in the future [5]. Some evidence showed that in the study in sub-Saharan African countries, nearly half (20–50%) of PLHIV want to have children [6].

Evidence-based research in Uganda, eastern Africa, found that nearly half (44%) of ART clients had fertility plans to achieve having a child, of whom the majority (35% ) were found to have challenges or fear of discussing these intentions with their HIV care providers [7].

A previous study conducted in Harari regional state, Ethiopia, found that more than half (56.2%) of people living with HIV have fertility desire [8]. The implications of ART for an HIV-infected individual’s (or couple’s) future fertility are generating growing interest [9] and Brazil [10]. One study reported a significant negative association between ART use and fertility desires in Nigeria [11].

According to the EDHS 2016, the country’s total fertility rate is 4.8% (2.6% in urban areas and 5.5% in rural areas) [10,12,13]. In general, in Ethiopia, the evidence is still inaccessible. That might be due to weak integrated activities of ART/PMTCT/FP services, viral load level, and other factors influencing the data handling system regarding fertility desire and factors associated with it. Therefore, this study tries to assess fertility desire and associated factors among PLHIVA who are taking ART/PMTCT services at Halaba zone, southern Ethiopia.

Two in every five pregnancies are not planned globally; women living with HIV are more at the danger of unintended pregnancies. Studies conducted in Africa including Ethiopia have indicated that, wanting to have children after ART/PMTCT initiation ranges from 31 – 60.9% (36.9%) [14-19].

A study in Harar Region ,Ethiopia indicated that Women have 58% times lesser fertility desire than men likewise age group 30-39 and Age >=40 have 61% and 85% times lesser fertility desire than 18-29 years respectively. Additionally, individuals who have a child in their life time have 76% times lesser desire than those who doesn’t ever have. Those who were not using family planning were three times higher to desire for a child than their counter parts and respondents who were not sexually active in the last six months have 77% times lesser fertility desire than those who were not [13].

Methods and Materials

Study Area and Period

The study was conducted in Halaba Zone Health Institutions. Halaba zone is located 315 KM away from Addis Ababa. It contains three woreda and one town administration. It has nine health centers and two hospitals.

The study was conducted at ART/PMTCT facilities in two public health centers & two hospitals kulito general & besheno primary hospitals. The estimated population of the Halaba zone. Based on the 2007 Census conducted by the Central Statistical Agency (CSA) of Ethiopia is 353,486 of this 42,353 people are living in Halaba town. Out of the Zone population 180, 278 are females with a pregnancy rate of 3.46% which implies the total number of expected women who give birth in a given year is 12,231 & as zonal level and ART service given at four health institution and their facilities HMIS & ART/PMTCT data showing currently on ART clients is 514. The study period was from Feb 17/2021 to Apr 17/2021G.C.

Study Design

A mixed facility based cross sectional study design was conducted.

Source Population

All PLWHIVA clients on ART/PMTCT within the reproductive age group female (15-49 years) and male 18 years and above living in the study area.

Study Population

Randomly selected PLHIVA clients on ART/PMTCT within the reproductive age group female (15-49 years old) and male 18years and above who fulfilled inclusion criteria and had follow-up for receiving care and treatment in ART units at selected four public health ART facilities of Halaba zone during the study period.

Inclusion Criteria

All PLWHIV who visited ART/PMTCT clinics of the health centers & hospitals at least one times and their age were 18years and above for men and reproductive age group (15-49 years old) for women and who appeared during the study period.

Exclusion Criteria

All PLWHIV who were unable to hear, not communicate, mentally disabled since they cannot provide responses for the study.

Sample Size Determination

The sample size is determined by single population proportion formula by taking the prevalence of 0.44 (21) obtained from a recent study conducted in Hawassa city hospitals and health center with assumption that of HIV positive individuals may desire and intend to have children with5% margin of error and 95% confidence interval (alpha=0.05). A non-response rate was assumed to be 10%. Based on these assumptions the actual sample size determined using the formula for single population proportion.

Where: n= (Za/2)² p(1-p)d²

• Proportion of fertility desire (p) = 0.44

• Level of Confidence 95 %

• Margin of error (d) = 5% , Non-response rate =10% Then sample size = 379

After adding non-response rate of 10% the final total sample size became 417 (379 + 38).

Sample Size Calculation for the Second Specific Objective (Table 1)