Study Charts Childbearing Desires and Expectations Among HIV-Positive Men and Women
Twenty-eight percent of HIV-positive heterosexual or bisexual men and 29% of HIV-positive women receiving medical care in the United States desire children, and of those who would like to reproduce, 59% of men and 69% of women actually expect to have one or more children in the future, according to a study published in the Alan Guttmacher Institute's July/August 2001 issue of Family Planning Perspectives. As effective therapies such as antiretroviral drugs have improved the prognosis of persons with HIV and reduced the risk of mother-to-child HIV transmission to only 2%, these individuals are "more frequently considering childbearing and parenthood." To address the parental desires and intentions of those with HIV, Dr. James Chen, who was with the School of Pharmacy and Institute for Health Policy Studies at the University of California-San Francisco during the study period, and colleagues at RAND conducted interviews with 1,421 HIV-positive adults who were participants in the HIV Cost and Services Utilization Study from September 1998 through December 1998. The proportion of HIV-positive women who desired children was less than the 36% of females in the general U.S. population who want to have children, and the percentage of HIV-positive women who expected to have a child (82% to 89%) but do not necessarily want to reproduce was lower than the 85% to 94% of U.S. women who expect to reproduce. However, researchers found that "being infected with HIV dampens but does not come close to eliminating individuals' desires and intentions to have children." The HCSUS study found that 12% of all HIV-positive women and 26% of those younger than 30 had children after being diagnosed with the virus.
Characteristics of Child Seekers
Chen and colleagues discerned that HIV-positive men and women who desire a child are typically younger, have fewer children and report better health than those who do not want children, although the desire is not related to measures of HIV progression. Some of the researchers' other findings include:
- HIV-positive individuals who expect to have children but who do not desire children are more likely younger, black and single. HIV-positive black men are five times more likely and black women are three times more likely to expect to have children than other races, the study found.
- While personal health status has a great effect on women's desire to have children, it does not have the same effect on men's desire. Yet health status "more strongly influences" men's expectations for children.
- Women who desired children were more likely to be married or have a partner (84%) than those who did not (64%). Women's partners' HIV status has "mixed effects" on their desire for and expectation of children; those who know their partner's HIV status, either positive or negative, are "significantly less likely" to want children but "significantly more likely" to expect them in the future than women who do not know their partners' HIV status.
- Fewer HIV-positive men and women expect to have children than desire them; 40% of men and 30% of women who desire kids do not expect to have them. Although both men and women report equal rates of desire for children, men are less likely to expect children, but more likely to expect to have two or more if they do. Researchers suggest that the discrepancy between fertility desires and expectations probably reflects a range of fertility decision factors, including the physical inability to have children due to sterilization and a partner's desire for children.
- Almost one-third of the total sample of HIV-positive women said that they "definitely" would have an abortion if they became pregnant, while a little more than one-third said they "definitely" would not. More than 50% of women who desired children said they would not have an abortion if they become pregnant, compared to 8% who would. "Importantly," the researchers pointed out, 27% of those who did not desire children would not seek an abortion if they became pregnant.