AEGiS-14IAC: On the contribution if HIV to fertility decline in Zimbabwe.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

On the contribution if HIV to fertility decline in Zimbabwe.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. C10711)

Gregson S, Terceira N, Zaba B, Mason PR
Imperial College Faculty of Medicine, London, United Kingdom

BACKGROUND: Lower fertility in HIV+ women slightly limits AIDS impact on early childhood mortality & orphanhood and can lead to understatement in HIV estimates from samples of pregnant women when contraceptive-use is low. This study quantifies the effect in a high contraceptive-use setting.

METHODS: Population survey of 5,307 women (80% participation) aged 15-49 yrs in Manicaland, 1998-2000. ICL dipstick test for HIV (sensitivity & specificity both 99.6%); commercial test for early pregnancy; self-report for late pregnancy. Odds ratios (OR) for recent birth & current pregnancy in HIV+ vs. HIV- women calculated using logistic regression adjusting for confounding factors. Separate models for effect modification by contraceptive use. Logistic regression to investigate mechanisms for HIV effect on fertility. Calculation of population-attributable change (PAC) in fertility.

RESULTS: Total fertility, 4.11 births per women; age at first sex (median), 18.4 yrs, recent use of modern contraception, 50.1%. Primary infertility (1.5%), syphilis (<1%), gonorrhoea (2.3%) & chlamydia (2.3%) uncommon. 25.4% HIV+. Recent birth (OR 0.84; 95% CI 0.69-1.03) & current pregnancy (0.62; 0.46-0.81) less common in HIV+ women but only in non-contraceptive users (p<0.05, in both cases). Effect appears to strengthen with longer duration of infection. Divorce, widowhood, sexual abstinence & history of genital discharge more common in HIV+ women; amenorrhoea in symptomatic women (p<0.05). No difference in miscarriage. Contraceptive use lower in HIV+ women (p<0.05). PAC in total fertility due to HIV, 6% - vs. 10% expected if low contraceptive-use.

CONCLUSIONS: HIV-associated sub-fertility has less effect in this high-contraceptive setting due to later onset of sex & low fertility at older ages. It still may account for 1/6th of the total fertility decline (5.5 to 3.96) in Zimbabwe since the 1980s. Actions to avoid HIV can also affect fertility.

Keywords: AEGIS, HIV, HIV Infections, Fertility, HIV Seropositivity, Contraceptive Agents, Zimbabwe, Acquired Immunodeficiency Syndrome, Contraception, HIV Seroprevalence, HIV Seronegativity, Human, Female, Pregnancy, immunology

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C10711