Determinants of Fertility Desires among HIV Positive Women Living in the Western Highlands Province of Papua New Guinea

Marie Lucy Aska, Jiraporn Chompikul, Boonyong Keiwkarnka

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DOI: 10.4236/wja.2011.14029                

Abstract

The objective of this study was to identify determinants of fertility desires in HIV positive women living in the Western Highlands Province, Papua New Guinea, a male-dominated, patrimonial society. A cross-sectional study was conducted to collect data in February, 2010. Two hundred and ninety one HIV-infected women participated in personal interviews using a structured questionnaire. Sixty-six percent of the respondents were in polygamous relationships. Thirty-four percent of the participants desired a child in the future. Chi-square tests revealed that variables associated with desire for a child were age, marital status, number of children, current co-habitation with a partner, duration of time with a partner, receipt of the bride price, domestic physical violence, sexual activity in the previous three months, partner’s desire for a child, and current contraceptive use. Using multiple logistic regression, a partner’s positive desire for a child was the strongest predictor, with an odds ratio of 13.04 (95% CI = 5.6 -29.91). Fertility desires were largely influenced by dominant culturally sensitive issues and the family-oriented culture. The integration of effective counseling and reproductive healthcare service into HIV clinics is recommended. Holistic, culturally-relevant and family-oriented reproductive health counseling should provide more positive outcomes for both HIV-infected women and their children.

Keywords

Fertility Desires, HIV Positive Women, Papua New Guinea, Reproductive Health, Patrimonial Society

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	UNAIDS, “2008 Report on Global AIDS Epidemic (Full Report),” 2009. http://www.unaids.org/en/KnowledgeCentre/HIVData/Global Report/2008/2008Global report.asp
[2]	UNAIDS, “AIDS and Gender Fact Shee,” 2008. http://womenandaids.unaids.org/publications_facts
[3]	WHO, “World Health Organization Constitution,” 2010. http://www.who.int/governance/eb/who_constitution
[4]	Centre of Disease Control and Prevention, “Current Trends Recommendation for Assisting in the Prevention of Perinatal Transmission of Human T-Lymphotropic Virus Type III Lymphadenopathy-Associated Virus and Acquired Immunodeficiency Syndrome,” Morbidity and Mortality Wee- kly Report, Vol. 34, 1985, pp. 721-726.
[5]	D. J. Smith and B. C. Mbakwem, “Life Projects and Therapeutic Itineraries: Marriage, Fertility, and Antiretroviral Therapy in Nigeria,” AIDS, Vol. 21, Suppl. 5, 2007, pp. S37-S41. doi:10.1097/01.aids.0000298101.56614.af
[6]	Centre of Disease Control and Prevention, “Recommendations of the US Public Health Service Task Force on the Use of Zidovudine to Reduce Perinatal Transmission of the Human Immunodeficiency Virus,” Morbidity and Mortality Weekly Report, Vol. 43, 1994, pp. 235-238.
[7]	L. Mandelbrot, L. J. Chenadec, A. Berrebi, et al., “Perinatal HIV-1 Transmission: Interaction between Zido- vudine Prophylaxis and Mode of Delivery in the French Prenatal Cohort,” Journal of the American Medical Association, Vol. 280, No. 1, 1998, pp. 55-60. doi:10.1001/jama.280.1.55
[8]	C. Kind, C. Rudin and C. A. Siegrist, “Prevention of Vertical HIV Transmission: Additive Protection Effect of Elective Caesarean Section and Zidovudine Prophylaxis,” AIDS, Vol. 12, No. 2, 1998, pp. 205-210. doi:10.1097/00002030-199802000-00011
[9]	S. Marina, F. Marina, R. Alcolea, et al., “Human Immunodeficiency Virus Type 1—Serodiscordant Couples Can Bear Healthy Children after Undergoing Intrauterine Insemination,” Fertil Steril, Vol. 70, No. 1, 1998, pp. 35-39. doi:10.1016/S0015-0282(98)00102-2
[10]	A. E. Semprini, P. Levi-Setti, P. Bozzo, et al., “Insemination of HIV Negative Women with Processed Semen of HIV Partners,” Lancet, Vol. 340, No. 8831, 1992, pp. 1317-1319. doi:10.1016/0140-6736(92)92495-2
[11]	Amnesty International Public Statement, “International Women’s Day: Failure to Respect the Rights of Women Deprives Us All,” 2010. http://www.amnesty.org/en/library/asset/ACT77/004/2009/
[12]	ICW, “International Community of Women Living with HIV/AIDS Goals,” 2010. http://www.icw.org/
[13]	A. Kline, J. Strickler and J. Kempf, “Factors Associated with Pregnancy and Pregnancy Resolution in HIV Seropositive Women,” Social Science & Medicine, Vol. 40, No. 11, 1995, pp. 1539-1547. doi:10.1016/0277-9536(94)00280-7
[14]	D. Ingram, S. Hutchinson, “Double Binds and the Reproductive and Mothering Experiences of HIV-Positive Women,” Qualitative Health Research, Vol. 10, No. 1, 2000, pp. 117-132. doi:10.1177/104973200129118282
[15]	M. S. Craft, R. O. Delaney, D. T. Bautista, et al., “Pregnancy Decisions among Women with HIV,” AIDS and Behavior, Vol. 11, No. 6, 2007, pp. 927-935. doi:10.1007/s10461-007-9219-6
[16]	B. Nattabi, J. Li, C. S. Thompson, et al., “A Systematic Review of Factors Influencing Fertility Desires and Intentions among People Living with HIV/AIDS: Implications for Policy and Service Delivery,” AIDS and Behavior, Vol. 13, No. 5, 2000, pp. 949-968.
[17]	H. Aka-Dago-Akribi, A. Desgrees Du Lou, P. Msellati, et al., “Issues Surrounding Reproductive Choices for Women Living with HIV in Abidjan, Coted’Ivoire,” Reproductive Health Matters, Vol. 7, No. 13, 1999, pp. 20-29.
[18]	A. A. Nobrega, A. F. Oliveira, T. M. Galvoa, et al., “Desire for a Child among Women Living with HIV/AIDS in Northeast Brazil,” AIDS Patient Care and STDs, Vol. 21, No. 4, 2007, pp. 261-267. doi:10.1089/apc.2006.0116
[19]	L. J. Chen, K. A. Phillips, D. E. Kanouse, et al., “Fertility and Intentions of HIV-Positive Men and Women,” Family Planning Perspectives, Vol. 33, No. 4, 2001, pp. 144- 152.
[20]	M. R. Loutfy, T. A. Hart, S. S. Mohammed, et al., “Fertility Desires and Intentions of HIV Positive Women of Reproductive Age in Ontarrio, Canada: A Cross-Sectional Study,” PLos One, Vol. 4, No. 12, 2009, pp. 1-10. doi:10.1371/journal.pone.0007925
[21]	L. Myer, C. Morroni and K. Rebe, “Prevalence and Determinants of Fertility Intentions of HIV-Infected Women and Men Receiving Antiretroviral Therapy in South Africa,” AIDS patient care and STDs, Vol. 21, No. 4, 2007, pp. 278-285. doi:10.1089/apc.2006.0108
[22]	World Health Organization, “Papua New Guinea Country Profile,” 2010. http://www.who.int/countries/png/en/
[23]	Amnesty International, “Violence against Women in Papua New Guinea,” September 2006. http://asiapacific.amnesty.org/library/
[24]	UNAIDS, “PNG UNGASS Country Report,” 2010. http://data.unaids.org/pub/Report/2008/papua_new_guinea_2008_country_progress _report_en.pdf
[25]	National AIDS Council Secretariat and National Department of Health (NACS and NDOH), “The 2007 Estimation Report on the HIV Epidemic in Papua New Guinea,” Port Moresby, 2007.
[26]	C. Jerkins, “HIV/AIDS; Culture and Sexuality in Papua New Guinea. Executive Summary,” 2010. http://www.adb.org/Documents/Books/Cultures-Contexts-Matter/HIV-PNG.pdf
[27]	UNAIDS, “PNG UNGASS Country Report,” 2010. http://data.unaids.org/pub/Report/2008/papua_new_guinea_2008_country_progress report_en.pdf
[28]	W. B. Miller, “Childbearing Motivations, Desires, and Intentions: A Theoretical Framework,” Genetic, Social & General Psychology Monographs, Vol. 120, No. 2, 1994, pp. 225-255.
[29]	M. Perugini and R. P. Bagozzi, “The Distinction between Desires and Intentions,” European Journal of Social Psychology, Vol. 34, No. 1, 2004, pp. 69-84. doi:10.1002/ejsp.186
[30]	N. McDowell, “Reproductive Decision Making and the Value of Children in the Rural Papua New Guinea,” Papua New Guinea Institute of Applies Social and Economic Research, Port Moresby, 1981.
[31]	S. Nakayiwa, B. Abang, L. Packel, et al., “Desire for Children and Pregnancy Risk Behaviours among HIV- Infected Men and Women in Uganda,” AIDS and Behavior, Vol. 10, Suppl. 1, 2006, pp. 95-104. doi:10.1007/s10461-006-9126-2
[32]	N. Ko and M. Muecke, “Reproductive Decision-Making Among HIV Positive Couples in Taiwan,” Journal of Nursing Scholarship, Vol. 37, No. 1, 2005, pp. 41-47. doi:10.1111/j.1547-5069.2005.00008.x
[33]	P. Oosterhoff, N. Anh Thu, N. Hnah Thuy, et al., “Holding the Line: Family Responses to Pregnancy and the Desire for a Child in the Context of HIV in Vietnam,” Culture, Health and sexuality, Vol. 10, No. 4, 2008, pp. 403-416. doi:10.1080/13691050801915192
[34]	S. Garap, “Kup Women for Peace: Women Taking Action to Build Peace and Influence Community Decision Making,” State, Society and Governance in Melanesia, 2004. http://dspace-prod1.anu.edu.au
[35]	M. Maier, I. Andia, N. Emenyonu, et al., “Antiretroviral Therapy Is Associated with Increased Fertility Desires, but Not Pregnancy or Live Birth, among HIV+ Women in the Early HIV Treatment Program in Rural Uganda,” AIDS and Behavior, Vol. 13, Suppl. 1, 2009, pp. 28-37. doi:10.1007/s10461-008-9371-7
[36]	S. Toft, “Domestic Violence in Papua New Guinea,” Law Reform Commission of Papua New Guinea, Port Moresby, 1985.
[37]	C. Bradley, “Family and Sexual Violence in Papua New Guinea: An Integrated Long-Term Strategy,” Report to the Family Violence Action Committee of the Consultative Implementation and Monitoring Council, Discussion Paper No. 84, Institute of National Affairs, Port Moresby, 2001.
[38]	R. A. da Silverira, G. A. Fonsechi-Carvasan, M. Y. Makuch, et al., “Factors Associated with Reproductive Options in HIV-Infected Women,” Contraception, Vol. 71, No. 1, 2004, pp. 45-50. doi:10.1016/j.contraception.2004.07.001